Patients give high marks to telehealth, J.D. Power says

The survey of more than 4,300 people ranked Amwell and Doctor on Demand as well as insurers. Sicker patients were less likely to report a positive experience.

By Ron Shinkman • Oct. 1, 2020

Election 2020: Trump and Biden's starkly diverging views on healthcare

Spoiler: the two nominees diverge on almost everything.

By Rebecca Pifer • Oct. 1, 2020

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

4M added to Medicaid rolls due to coronavirus pandemic

The job market — which many rely on for commercial insurance coverage — is likely to remain strained as long as the U.S. fails to contain the spread of the novel coronavirus. The resulting shift in payer mix is unfavorable for providers.

By Samantha Liss • Oct. 1, 2020

$6B fraud bust includes numerous telehealth schemes

Providers quickly pivoted many services to virtual care during the COVID-19 pandemic, potentially inviting fraud.

By Shannon Muchmore • Oct. 1, 2020

Providers win Medicare loan extension, DSH relief but lose other asks in stop-gap spending law

The law signed by the president Thursday is likely the only direct aid providers can expect before the November presidential election, after Congress deadlocked on further COVID-19 legislation.

By Rebecca Pifer • Oct. 1, 2020

Anthem to pay almost $40M to settle 2015 cyberattack investigation

The settlement ends a long-standing investigation into the payer following a series of targeted hacks that exposed the health information of almost 79 million people. Anthem continues to deny any wrongdoing.

By Hailey Mensik • Sept. 30, 2020

Provider finance execs bracing for unfavorable shift in payer mix, survey finds

About 70% of CFOs and revenue cycle leaders are readying for a drop in commercially insured patients — a highly prized cohort for providers and health systems.

By Samantha Liss • Sept. 30, 2020

Molina's $380M buy vastly boosts managed care footprint in New York

The acquisition of Affinity Health Plan will add 284,000 Medicaid members, a significant increase as the payer climbs the ranks in a state currently dominated by rival Centene.

By Shannon Muchmore • Sept. 29, 2020

CMS touts dip in Medicare Advantage premiums for 2021

SVB Leerink analysts point to Centene, Humana and UnitedHealthcare as payers best positioned to pick up more share next year.

By Samantha Liss • Sept. 25, 2020

It's high time payers opened the digital front door

A digital front door helps health plans to improve member satisfaction, quality outcomes and costs.

By Heather Staples Lavoie, President and CEO, Geneia • Sept. 25, 2020

Medicare Advantage should not 'game the system' but prioritize patient care, honest billing

The HHS Office of Inspector General's principal deputy warns, "My office and other government agencies are targeting oversight to make sure plans do not pad risk adjustments with unsupported diagnoses."

By Christi A. Grimm • Sept. 23, 2020

Payers, other stakeholders urge Congress to blunt COVID-19-spurred insurance losses

"The odds are we are on track to having the greatest coverage losses we've ever recorded," Stan Dorn, director of the National Center for Coverage Innovation and senior fellow at Families USA, said during a briefing Tuesday.

By Samantha Liss • Sept. 23, 2020

Centene sues drugmaker Indivior over 'profit protection scheme'

The payer is seeking to recoup money it paid for opioid addiction medicines that should have had generic equivalents — or cheaper alternatives. It alleged the drug company devised a plan to box out competitors.

By Samantha Liss • Updated Sept. 23, 2020

CMS to expand ambulance prior authorization model nationwide

The model saved Medicare about $650 million in four years without changing care quality or access. However, the timeline for its rollout is still to be determined amid COVID-19 uncertainty.

By Rebecca Pifer • Sept. 23, 2020

'We feel bullish': Payers look ahead to 2021

Top execs at the biggest commercial insurers outlined shifting strategic priorities and growth opportunities in light of the COVID-19 recession at Morgan Stanley's annual healthcare conference last week.

By Rebecca Pifer • Sept. 17, 2020

CMS innovation agency to launch risk-based model for dual eligibles

Along with the dual-eligible demonstration, CMMI head Brad Smith said Tuesday industry could expect some additional models to come out of the pipeline in the next few months.

By Rebecca Pifer • Sept. 16, 2020

In deal with Apple, CVS clients get temporary access to new fitness feature

CVS CEO Larry Merlo also gave an update at Morgan Stanley's annual healthcare conference on its conversion of retail locations to HealthHUBs.

By Rebecca Pifer • Sept. 16, 2020

Uninsured rate rose to 9.2% in US last year, pre-COVID-19 recession

The high cost of U.S. healthcare continues to stress the country's economic outlook overall. About 7.7 million more Americans would be considered low-income if their medical bills were factored in, the U.S. Census Bureau said.

By Rebecca Pifer • Sept. 16, 2020

Cigna rebrands health services division, including Express Scripts, as Evernorth

The move is an evolution for the Cigna-Express Scripts tie-up completed in late 2018, as the combined entity looks to spur more interest in its products from third parties.

By Rebecca Pifer • Sept. 16, 2020

ACOs in Medicare Shared Savings Program post third year of savings

But the National Association of Accountable Care Organizations said only 5% of eligible ACOs took CMS’ offer on the Pathways to Success program structure early and instead chose to remain under the previous rules.

By Hailey Mensik • Sept. 15, 2020

Centene added 1.1M members since March amid COVID-19 job losses

The payer also announced a partnership with Samsung to give 13,000 smartphones to patients in rural and underserved areas to help increase access to virtual care.

By Rebecca Pifer • Sept. 15, 2020

CMS to ax inpatient data in MA risk scoring by 2022

The proposed changes should be a net positive for Medicare Advantage players, resulting in a 0.25% rise in risk scores.

By Rebecca Pifer • Sept. 15, 2020

CMS kills controversial Medicaid fiscal accountability rule

The rule proposed last year would have increased federal oversight of how states fund their Medicaid programs and potentially resulted in funding cuts for the cash-strapped program. Providers strongly opposed it.

By Rebecca Pifer • Sept. 14, 2020

Centene adds ACA offerings in 400 new counties, 2 new states for 2021

Despite the challenges and uncertainty brought on by the pandemic, the payer with the largest presence in the exchanges will now be in New Mexico and Michigan as well.

By Samantha Liss • Sept. 11, 2020

Employers struggling to calculate 2021 medical cost trends due to COVID-19: Credit Suisse

A survey run by the financial services firm found 60% of employers are trying to adjust 2020 claims data to normalize for the pandemic's effects while calculating expected medical cost trend next year.

By Rebecca Pifer • Sept. 11, 2020