Payer: Page 65
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Samantha Liss/Healthcare Dive
Centene acquires analytics firm Apixio for undisclosed sum
Healthcare companies are increasingly turning to AI and machine learning tools to streamline administrative functions, with the goal of cutting down on waste and saving money.
By Rebecca Pifer • Nov. 9, 2020 -
CVS' Merlo to depart, replaced by veteran payer exec Karen Lynch
The company beat Wall Street expectations with revenue of $67 billion in the third quarter, up 3.5% year over year as its diversified book of business helped blunt the impact of coronavirus-related headwinds.
By Rebecca Pifer • Nov. 6, 2020 -
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 -
Cigna sees medical utilization bounce back in Q3
Executives had expected health spending to rise toward the end of the year as patients returned to the healthcare setting after putting off care amid the COVID-19 pandemic.
By Samantha Liss • Nov. 5, 2020 -
Biden faces a divided Congress, stifling chance for more progressive health policies
Former Vice President Joe Biden won the U.S. presidency, the Associated Press and all the major networks said, after votes were tallied in Pennsylvania on Saturday.
By Shannon Muchmore • Updated Nov. 7, 2020 -
Docs paid by ICD makers more likely to favor manufacturer: JAMA study
Yale researchers found patients were more likely to receive certain cardiac devices from the company that made the largest payment to their doctor, though quality of care did not appear to be affected.
By Susan Kelly • Nov. 4, 2020 -
Humana warns of Q4 loss amid increased COVID-19 costs, rebounding utilization
"We continue to expect our results for the second half ... to entirely offset the significant outperformance experienced in the first half of the year that resulted from historically low medical utilization levels," CFO Brian Kane said.
By Samantha Liss • Nov. 3, 2020 -
Photography by Gage Skidmore / Photo Illustration by Kendall Davis / Industry Dive
Healthcare Dive's 2020 election coverage
The outcome of the presidential race and control of the Senate were still unknown. Polling showed healthcare issues were top of mind for many as they cast their vote.
Nov. 2, 2020 -
Permission granted by Larry Bridges
Q&AThoughts on diversity in healthcare C-suite from an executive search specialist
The COVID-19 pandemic harshly exposed racial disparities in treatment and care outcomes that remain across the country, and the healthcare industry has a long way to go in diversity and inclusion among its ranks.
By Shannon Muchmore • Nov. 2, 2020 -
CMS set to bump MA rates for 2022 in win for payers
The agency is also proposing to rely entirely on encounter data to calculate patient risk scores in 2022, a move that has been opposed by commercial insurers.
By Samantha Liss • Nov. 2, 2020 -
CMS clears Georgia bid to nix Healthcare.gov, decentralizing ACA marketplace
If implemented, the state would be the first with no government-run website to enroll in ACA plans, decentralizing marketplace functions among a few private insurers. Some call it an illegal move that would push thousands off the rolls.
By Rebecca Pifer • Nov. 2, 2020 -
Molina saw members return to care in Q3, braces for curtailment as cases spike again
The payer reported it spent $35 million on COVID-19 care in the quarter. But as cases reach new heights in the U.S., it expects members to again defer care as virus costs are likely to increase.
By Samantha Liss • Oct. 29, 2020 -
Aetna to pay $1M to settle 3 patient data HIPAA breaches
The potential violations all occurred over a six-month period in 2017 and affected a total of more than 18,000 members, the HHS Office for Civil Rights said. The payer is not admiting liability.
By Shannon Muchmore • Oct. 29, 2020 -
Telehealth claim lines flat following 2 months of declines, Fair Health says
The South, which was particularly hard-hit by the COVID-19 pandemic over the summer, saw the biggest month-over-month rise in telehealth claim lines, rising 9.7%, according to the analysis.
By Rebecca Pifer • Oct. 29, 2020 -
Permission granted by BioNTech SE
CMS requires government, most private plans to cover COVID-19 vaccines
Commercial payers are likely already modeling costs. Anthem CEO Gail Boudreaux said Wednesday the insurer considered multiple variables when determining pricing and will follow CMS guidance.
By Shannon Muchmore • Updated Oct. 29, 2020 -
Brian Tucker/Healthcare Dive
Final rule requires health plans to make negotiated rates public
CMS Administrator Seema Verma fought back against claims the regulation will stifle competition. "Don't be fooled ... such complaints are all about protecting a considerable profit special interest reaped from business as usual," she said.
By Shannon Muchmore • Oct. 29, 2020 -
Anthem beats in Q3, but profit plummets amid rising costs
The payer also reported a $594 million payment toward a federal antitrust settlement reached with Blue Cross Blue Shield plans that is still awaiting approval by a judge.
By Shannon Muchmore • Oct. 28, 2020 -
Task force proposes lowering colorectal cancer screening age to 45
The U.S. Preventive Services Task Force recommendations are used to decide services that have to be covered at no copay under the Affordable Care Act.
By Nick Paul Taylor • Oct. 28, 2020 -
Samantha Liss/Healthcare Dive
Centene Q3 profit skyrockets on WellCare close, ACA settlement
Lower utilization of healthcare services during the quarter was partially offset by higher testing and treatment costs for COVID-19, the payer said. Analysts called the results "good enough."
By Samantha Liss • Oct. 27, 2020 -
Master Sgt. Hecht, Matt. (2020). [Photograph]. Retrieved from Flickr.
4 healthcare storylines overshadowed by COVID-19
The magnitude of the crisis has all but stopped some efforts, like a ban on surprise billing. But other policies are forging ahead, including price transparency requirements for hospitals beginning Jan 1.
By Shannon Muchmore • Oct. 22, 2020 -
Envision, Cigna avert out-of-network status in Florida
A deal between the private equity-backed staffing group and insurer ensures that thousands of clinicians remain in network during a deadly pandemic, averting potential for surprise medical bills.
By Samantha Liss • Oct. 22, 2020 -
COVID-19 has sparked more concerns about healthcare costs, insurance, TransUnion says
More people, especially those in younger generations, are using insurer websites to conduct cost research, the annual survey found.
By Ron Shinkman • Oct. 21, 2020 -
ACA plan premiums to fall 2% in 2021, CMS says
The price easing comes despite the Trump administration's efforts to chip away at the law, including support for the case to overturn it now before the Supreme Court. But affordability remains a challenge for some who don't get subsidies.
By Rebecca Pifer • Oct. 20, 2020 -
CVS wants pharmacy techs to administer COVID-19 vaccine, plans to hire 10,000 more
This week the Trump administration released guidance authorizing pharmacy technicians and pharmacy interns to administer coronavirus vaccines and COVID-19 diagnostic tests.
By Rebecca Pifer • Updated Oct. 23, 2020 -
MA plans see more minorities, dual eligibles signing up
Medicare Advantage has been a key revenue driver for big payers like UnitedHealth and Cigna, which are expanding their footprints.
By Shannon Muchmore • Oct. 16, 2020 -
Brian Tucker/Healthcare Dive
CMS grants Medicaid waiver to Georgia; exchange opt-out remains on table
The agency has approved a modest Medicaid expansion waiver for Georgia, and is apparently nearing OK of a second waiver that would allow the state to stop using the Healthcare.gov insurance exchange.
By Ron Shinkman • Oct. 15, 2020
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