Payer: Page 6
-
stock via Getty Images
Deep DiveA Cigna-Humana merger could face a long regulatory delay. But it might get approved.
As rumors swirl that the two major health insurers are inching toward a merger, experts say antitrust agencies have grounds to block a deal — but may not be successful.
By Rebecca Pifer • Dec. 4, 2023 -
Permission granted by Pegasystems
Sponsored by PegasystemsEnhanced human potential: How customer service technology increases empathy
Elevance Health’s Geeta Wilson talks about improving operational efficiencies while enhancing member and associate satisfaction.
By Christopher Patterson, VP Product Strategy, Pegasystems • Dec. 4, 2023 -
Explore the Trendline➔
RossHelen via Getty Images
TrendlineSocial determinants of health
The focus on social determinants of health has only increased because of the impacts of the pandemic, with payers and providers trying to new ways to address the issues.
By Healthcare Dive staff -
Sean Pavone via Getty Images
North Carolina Medicaid expansion kicks in
About 600,000 more people in the state now have access to the safety-net insurance coverage.
By Rebecca Pifer • Dec. 1, 2023 -
Courtesy of UnitedHealth Group
Medicare Advantage rate change bedevils UnitedHealth’s 2024 outlook
UnitedHealth’s MA growth could be depressed next year thanks to a rate notice from the CMS that’s deeply unpopular with insurers, management said during an investor day.
By Rebecca Pifer • Nov. 30, 2023 -
Illustration: Xavier Lalanne-Tauzia for Industry Dive
Highmark Health’s insurance business boosts earnings
The insurance arm pushed the healthcare parent company to positive results during the first nine months of 2023 after its provider arm, Allegheny Health, reported an operating loss.
By Susanna Vogel • Nov. 29, 2023 -
Matt Slocum/AP
Cigna, Humana in talks to merge: WSJ
The merger would have major effects on the makeup of the U.S. health insurance industry, and would almost certainly face a regulatory challenge.
By Rebecca Pifer • Nov. 29, 2023 -
Sensay via Getty Images
Global medical costs to dip in 2024 — but respite may not last long, research finds
Medical costs will continue to rise over the next few years, according to WTW. Surveyed insurers blamed expensive medical technologies and an overuse of health services.
By Susanna Vogel • Nov. 29, 2023 -
Gerenme via Getty Images
Majority of Medicaid enrollees satisfied with plans, despite flaws, survey finds
Medicaid enrollees are more likely to understand and be satisfied with their plans, despite reporting poorer health outcomes, according to a new report from KFF.
By Susanna Vogel • Nov. 29, 2023 -
Staff via Getty Images
Sponsored by PegasystemsAI to take center stage in healthcare in 2024
Five predictions on how AI will change healthcare.
By Robert Connely, Global Market Leader for Healthcare, Pegasystems • Nov. 27, 2023 -
erdikocak via Getty Images
Average per-worker cost of health benefits rose by 5.2% in 2023: survey
Inflation is a contributor to the increase, but rising prescription drug costs are likely to have a longer-term impact, according to a Mercer report.
By Emily Olsen • Nov. 22, 2023 -
iStock / Getty Images Plus via Getty Images
Insurers’ financial outlook stable despite higher MA utilization: Moody’s
Publicly traded health insurers’ financial results held steady in the third quarter, boosted by strong investment income and membership growth, according to the credit ratings agency.
By Emily Olsen • Nov. 22, 2023 -
Alex Wong via Getty Images
CMS proposes stricter network adequacy standards for plans in state-run ACA exchanges
Beginning in 2025, plans sold in state-based exchanges would be required to meet time and distance standards for provider access under a new rule proposed Wednesday.
By Rebecca Pifer • Nov. 16, 2023 -
Samantha Liss/Healthcare Dive
Centene names new COO following leadership turnover
Current SVP Susan Smith will take the reins as the health insurer’s chief operating executive starting next year.
By Rebecca Pifer • Nov. 15, 2023 -
Courtesy of UnitedHealth Group
UnitedHealth sued over use of algorithm to deny care for MA members
The lawsuit alleges UnitedHealth used nH Predict to deny claims despite the algorithm’s determinations being overturned in more than 90% of appeals.
By Rebecca Pifer • Nov. 15, 2023 -
Kameleon007 via Getty Images
State Medicaid officials project enrollment nosedive next year amid unwinding
Enrollment in the safety-net insurance program could plummet 8.6% in the 2024 fiscal year — the largest year-over-year drop since 1998, according to KFF.
By Rebecca Pifer • Nov. 14, 2023 -
Tippapatt via Getty Images
New AMA policies focus on GLP-1 coverage, resisting corporate medicine
The lobbying group advanced a range of policy resolutions it says will advance access to patient care at its annual interim meeting.
By Susanna Vogel • Nov. 14, 2023 -
Smartboy10 via Getty Images
Sponsored by Rise to Health CoalitionHow payers can advance health equity as part of coordinated action
When discussing the gap between the status quo and safe, high-quality healthcare, many organizations realize that improving health equity is a moral and economic imperative as the business case for equity is well-documented.
Nov. 13, 2023 -
Samara Heisz via Getty Images
Optum Rx moves 8 insulins to preferred formulary status as pressure mounts on PBMs
The drugs shifting to preferred status — meaning they’ll be available for under $35 per month in out-of-pocket costs — were previously on tier three or excluded altogether from the pharmacy benefit manager’s formulary lists.
By Rebecca Pifer • Nov. 10, 2023 -
Getty Images
Medicare Advantage seniors have better health outcomes, study finds
New research from Harvard and Inovalon found MA beneficiaries had fewer hospital readmissions, fewer preventable hospitalizations and lower rates of high-risk medication use than those in traditional Medicare.
By Rebecca Pifer • Nov. 9, 2023 -
erdikocak via Getty Images
Biggest takeaways from health insurers’ third-quarter earnings
Many payers beat Wall Street expectations in the quarter, despite ongoing utilization concerns. Other hot topics? Medicare Advantage stars, Medicaid redeterminations, individual exchange growth and GLP-1s.
By Rebecca Pifer • Nov. 8, 2023 -
Getty Images
Biden administration proposes capping broker payment in MA, following pressure
The new proposed rule is meant to stop brokers from steering beneficiaries to plans based on excessive compensation. It’s regulators’ latest move to curb Medicare Advantage marketing misconduct following a push from lawmakers.
By Rebecca Pifer • Nov. 7, 2023 -
Kameleon007 via Getty Images
Medicaid disenrollments pass 10M as states continue eligibility checks
States have assessed the eligibility of 28 million Americans to date, and terminated coverage for 35% of them, according to the latest data from KFF.
By Rebecca Pifer • Nov. 6, 2023 -
Alex Wong / Staff via Getty Images
CMS finalizes 2024 Medicare hospital, doctor payments, 340B fix and price transparency requirements
Regulators finalized a number of rules Thursday with sweeping implications for providers in the Medicare program, including rates for next year that doctors and hospitals slammed as insufficient.
By Rebecca Pifer • Nov. 3, 2023 -
Kaarin Vembar/Healthcare Dive
Walmart inks partnerships with health system, insurer in Florida
The partnerships — which include Walmart Health’s first patient care coordination agreement with a health system — aim to improve care coordination and referrals from its 23 health centers in the state.
By Emily Olsen • Nov. 2, 2023 -
Julia Rendleman via Getty Images
Cigna raises 2023 membership outlook amid healthier economy
An expected economic downturn has yet to materialize, leading Cigna to say Thursday it plans to add at least 1.6 million members this year, up from previous forecasts.
By Rebecca Pifer • Nov. 2, 2023
Previous
