Payer: Page 62
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Scott Eisen via Getty Images
Preventable hospitalization costs among unvaccinated patients surged to $3.7B in August, KFF says
More than 280,000 hospitalizations from COVID-19 between June and August could have been prevented by vaccination, researchers found.
By Rebecca Pifer Parduhn • Sept. 14, 2021 -
Courtesy of Humana
Humana's reported rise in hospitalizations among seniors is a trend worth watching
It's potentially troubling because people who are eligible for Medicare have a higher vaccination rate than the rest of the population. Humana's report raises questions about what's driving the uptick in hospitalizations among this cohort.
By Samantha Liss • Sept. 13, 2021 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/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 -
Alex Wong via Getty Images
Biden pushes forward on Medicare price negotiation
But opposition from the drug industry and Republicans could make the Democrats' signature proposal an uphill battle.
By Jonathan Gardner • Sept. 13, 2021 -
Mario Tama via Getty Images
Insurers to disclose relationships with brokers, agents in new CMS proposed rule
Other proposals would require air ambulances to disclose additional data to HHS and outline how CMS can enforce surprise billing protections if states fail to act.
By Rebecca Pifer Parduhn • Sept. 13, 2021 -
Permission granted by Biogen
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 -
Surprise Billing
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 -
Alex Wong via Getty Images
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 Parduhn • Sept. 8, 2021 -
Courtesy of Humana
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 Parduhn • Sept. 1, 2021 -
Megan Quinn/Healthcare Dive
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 Parduhn • 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 Parduhn • Aug. 31, 2021 -
Scott Eisen via Getty Images
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 Parduhn • 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 -
Retrieved from Abbott/PRNewswire on June 15, 2020
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 -
Spencer Platt via Getty Images
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 Parduhn • 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 Parduhn • Aug. 18, 2021 -
Retrieved from Paul Sableman on March 12, 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 -
Medicaid redeterminations
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 Parduhn • 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 Parduhn • Aug. 16, 2021
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