Biogen offered a window into what's holding up Aduhelm. Investors didn't like what they saw.

At Morgan Stanley’s healthcare conference, executives detailed how the launch of their Alzheimer’s drug has been slower than expected, due in large part to lingering questions about clinical trial data and insurance coverage.

By Jacob Bell • Sept. 10, 2021

Industry pushes for more time before surprise billing ban enforced

Payers and hospitals say with the COVID-19 pandemic ongoing and key elements still unreleased, it will be difficult to comply by Jan. 1. Key sticking points include arbitration and qualified payment amounts.

By Shannon Muchmore • Sept. 9, 2021

Explore the Trendline➔

Payer/provider relationships

As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.

By Healthcare Dive staff

Biden admin shells out $452M to boost state reinsurance programs

The funding is aimed at getting more individuals to enroll in insurance at a lower cost, swelling coverage as the COVID-19 pandemic continues, HHS Secretary Xavier Becerra said.

By Rebecca Pifer • Sept. 8, 2021

Humana reports uptick in MA hospitalizations, dip in non-COVID-19 admissions

An anticipated decline in non-COVID-19 care is expected to offset any increases incurred by COVID-19 testing and treatment costs, the insurer said Tuesday.

By Samantha Liss • Sept. 8, 2021

Actuaries suggest individual insurance premiums won't see large swings in 2022

There is more information available now about how COVID-19 continues to affect healthcare spending and utilization, unlike the 2021 rate-setting season, and "those impacts are not expected to be material," according to a report.

By Samantha Liss • Sept. 3, 2021

Medicare insolvency still expected by 2026, unchanged by COVID-19, trustees say

The forecast is a bit of a bright spot for the otherwise grim financial prospects of the program, as experts worried COVID-19 would result in the fund that finances Medicare Part A running out of money faster than previously expected.

By Rebecca Pifer • Sept. 1, 2021

Hospital lobby urges Congress to extend Medicare cut relief

The cuts, if they go through, will result in an estimated loss of $36 billion in funding in 2022 alone, the Federation of American Hospitals said.

By Rebecca Pifer • Sept. 1, 2021

Sutter to pay $90M in largest False Claims Act settlement against a health system for alleged MA fraud

The record payment comes on the heels of another massive settlement for the nonprofit, adding to the hit on its already stressed bottom line.

By Rebecca Pifer • Aug. 31, 2021

Cigna to expand ACA footprint to 3 new states, 93 new counties next year

The expansion, which is pending regulatory approval, means Cigna's exchange footprint now spans 13 states, and puts some 1.5 million additional consumers within reach.

By Rebecca Pifer • Aug. 26, 2021

Florida Blue parent GuideWell to acquire Puerto Rico's BCBS carrier

One aim of the deal is to provide a more competitive Medicare Advantage product in Florida and Puerto Rico, executives outlined in a letter to other Blue Cross Blue Shield CEOs.

By Samantha Liss • Aug. 25, 2021

Nevada awards Medicaid contracts to 4 insurers

It's a big win for Molina, which will join three incumbents in the state: UnitedHealthcare, Centene and Anthem Blue Cross Blue Shield.

By Samantha Liss • Aug. 25, 2021

Diabetes screening advised to start at age 35 for overweight, obese people

While the screening recommendation could lead to more treatment, and therefore more costs to health insurers, catching the disease earlier may save money in the long run.

By Susan Kelly • Aug. 25, 2021

Medicaid, ACA policies for COVID-19 kept rate of uninsured steady, researchers find

The uninsured rate remained at 11% from March 2019 to April 2021, thanks to a freeze in Medicaid disenrollment and increased ACA subsidies, according to a report from the Urban Institute.

By Hailey Mensik • Aug. 24, 2021

Unvaccinated COVID-19 hospitalizations costing US healthcare system billions, KFF says

Roughly 113,000 of the 185,000 inpatient stays with a COVID-19 diagnosis, or about 61%, could have been prevented by vaccination in June and July, researchers estimated.

By Rebecca Pifer • Aug. 24, 2021

Many insurers are no longer waiving cost sharing for COVID-19 treatment

This may pose a new strain for providers as people in the U.S. are left to cover their out-of-pocket costs, according to a report from the Kaiser Family Foundation.

By Samantha Liss • Aug. 20, 2021

SSM Health, insurer Medica to launch joint venture

Medica will invest an undisclosed sum in Dean Health Plan, a subsidiary of St. Louis-based SSM Health, one of the nation's largest nonprofit health systems.

By Samantha Liss • Aug. 19, 2021

Payments to MA plans raised overall Medicare spend by $7B in 2019, analysis finds

The Kaiser Family Foundation chalked the higher spending up to how MA is paid, including how benchmarks for plan payments are set and the risk adjustment process.

By Rebecca Pifer • Aug. 18, 2021

Centene's Medicare CFO promoted to segment CEO

Rich Fisher's promotion comes weeks after the insurer reported a $535 million quarterly loss but a 25% growth in its Medicare business.

By Jane Thier • Aug. 17, 2021

CMS extends deadlines for Medicaid redeterminations after COVID-19 public health emergency ends

Due to significantly increased workloads, state health officials will now have 12 months instead of six after the PHE ends to complete pending verifications, redeterminations and renewals.

By Hailey Mensik • Aug. 17, 2021

Centene awarded Ohio Medicaid contract following $88M settlement

In addition, a subsidiary of Molina has nabbed a Medicaid contract win in Nevada, the payer's first in the state.

By Rebecca Pifer • Aug. 17, 2021

UnitedHealthcare loses Medicare Advantage overpayment suit

An appeals court has reversed a 2018 decision overturning Medicare's overpayment rule that required insurers to refund reimbursement to CMS within 60 days if they learn a diagnosis lacks medical record support.

By Rebecca Pifer • Aug. 16, 2021

AI gains steam, though some execs still not sold at HIMSS21

Data released Wednesday finds 7% of healthcare executives said they believe AI and machine learning are the top priority for the future, while 7% called them a "distraction."

By Rebecca Pifer • Aug. 13, 2021

Predicting the future of healthcare: 10 takeaways from HIMSS21

Along with "guarded optimism" on the current state of the pandemic, some 19,000 on-site attendees in Las Vegas mulled what's next for AI, telehealth, cybersecurity, mental health and more.

By Rebecca Pifer , Hailey Mensik • Aug. 13, 2021

UnitedHealth settles for $15.6M after Labor Department finds mental health cuts, denials

"You should expect to see more investigation," of those not abiding by the federal mental health parity law, a top DOL official said. "I predict this will be a very active issue for us for years to come."

By Shannon Muchmore • Aug. 12, 2021

Health equity takes center stage at HIMSS21

Significant racial gaps in receiving vaccinations remain, despite the ongoing push to inoculate a greater swath of the U.S. population as the delta variant drives a surge in COVID-19 cases.

By Rebecca Pifer • Aug. 11, 2021