Payer: Page 65
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Payers win again, court rules Trump admin violated law in axing ACA cost-sharing payments
Judges said, however, that insurers able to raise premiums to offset the loss of the payments in 2018 should not receive the entire unpaid amount.
By Shannon Muchmore • Aug. 14, 2020 -
Oklahoma pulls Medicaid block grant application
The move comes after the state's voters narrowly approved Medicaid expansion last month and is a blow to the Trump administration's attempt to overhaul the program with block grants, long a conservative policy goal.
By Hailey Mensik • Aug. 14, 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 -
As Congress eyes an inquiry into insurer profits, experts caution they may not last
"One thing that we can be certain of is that the lower level of claims cost experienced in the second quarter will not continue indefinitely," Bradley Ellis, senior director of North American insurance ratings for Fitch Ratings, said.
By Samantha Liss • Aug. 12, 2020 -
Biden VP pick Harris, early backer of 'Medicare for All,' later pivoted
Among the largest donors to Sen. Kamala Harris' primary run were workers, owners and political action committees associated with healthcare powerhouse Kaiser Permanente.
By Shannon Muchmore • Aug. 12, 2020 -
20 state AGs urge Trump admin to nix proposed tax breaks for health sharing ministries
Saying it would undermine the Affordable Care Act and encourage fraud, the attorneys general called a draft rule arbitrary and particularly dangerous amid the COVID-19 pandemic.
By Ron Shinkman • Aug. 12, 2020 -
Trump tries to revamp drug supply chain with latest order
A directive announced by the president Thursday would require government agencies to buy certain "essential" drugs from factories in the U.S. How easily such an order would be implemented isn't clear.
By Ben Fidler • Aug. 7, 2020 -
Payers saw massive Q2 profits as COVID-19 deferred care
Anthem, UnitedHealth and Centene reported at least doubling profits for the quarter. Meanwhile, CVS-owned Aetna and Humana raised their 2020 earnings outlooks.
By Shannon Muchmore • Aug. 7, 2020 -
DOJ sues Cigna, alleging $1.4B in Medicare Advantage fraud
The payer used a medical assessment program to find health conditions that could raise risk scores of plan members, offering incentives to physicians who gave the exam, according to the lawsuit.
By Hailey Mensik • Aug. 6, 2020 -
Fresh off Medicaid win in Missouri, Fairness Project calls for health industry to step up
"We need to see health insurers and private hospitals step up and make massive investments in these campaigns," Jonathan Schleifer, executive director of the D.C.-based advocacy group, told Healthcare Dive.
By Samantha Liss • Aug. 6, 2020 -
Bruce Bennett via Getty Images
CVS profit soars to $3B on lower medical utilization
The performance of CVS' health benefits arm, which includes major commercial payer Aetna, more than offset a sharp earnings drop in its retail segment as COVID-19 slashed foot traffic to its brick-and-mortar locations.
By Rebecca Pifer • Aug. 5, 2020 -
iRhythm stock leaps 33% after CMS pitches new reimbursement codes
Permanent codes validate the digital health company's wearable heart monitoring technology and could drive more widespread adoption for detection of atrial fibrillation and other abnormal rhythms, CEO Kevin King said.
By Susan Kelly • Aug. 5, 2020 -
Humana joins peers in reporting depressed usage, larger income in Q2
The payer increased its outlook for earnings and individual Medicare Advantage membership as it saw revenue jump about 17% in the quarter.
By Samantha Liss • Aug. 5, 2020 -
The White House/Healthcare Dive, data from WhiteHouse.gov
CMS expands telehealth coverage in physician fee rule following Trump executive order
The agency proposed making permanent almost two dozen new telehealth codes. A notable exception is Medicare's temporary reimbursement for audio-only visits, though the agency did ask for public input on the omission.
By Rebecca Pifer • Aug. 4, 2020 -
Oscar expands into 4 new states, touts new virtual primary care option
Flush off raising $225 million in late-stage funding last month and a new initiative with Cigna to sell coverage to small businesses, the startup is looking to grow.
By Ron Shinkman • July 31, 2020 -
Molina Q2 profit surges 40% as provider volumes wane
The MCO joined other insurers in posting big profit gains, though it has yet to revise its full-year earnings forecast amid continued COVID-19 uncertainty.
By Samantha Liss • July 31, 2020 -
Medicaid managed care rates on state chopping blocks, with Centene and Molina at risk
Centene execs this week declined to quantify how reductions by states facing shortfalls may impact financial performance or guidance, while Molina provided a direct estimate on Friday.
By Samantha Liss • July 31, 2020 -
Cigna beats in Q2 as commercial enrollment nearly steady despite pandemic
The payer posted profit of $1.75 billion, up nearly 25% year over year. Like other insurers, the company saw increased profit as people deferred care in April and May to forgo potential exposure to the novel coronavirus.
By Shannon Muchmore • July 30, 2020 -
HHS prods Congress to act on surprise billing, but doesn't take a side on how
Congress has taken some action on surprise billing in the face of the coronavirus pandemic, barring the practice for COVID-19 testing and treatment during the public health emergency. Still, a larger overhaul is unlikely soon.
By Shannon Muchmore • July 29, 2020 -
Anthem posts $2.3B profit in Q2 as Medicaid growth outpaces commercial losses
Like for other payers, the COVID-19 pandemic has tamped down healthcare use and resulting costs. Executives said utilization among members was down about 40% in April and 20% in May but returned nearly to baseline last month.
By Shannon Muchmore • July 29, 2020 -
Telehealth made up almost half of all Medicare beneficiaries' primary care use in April
Fee-for-service beneficiaries adopted telehealth for primary care at unprecedented rates as COVID-19 spread in the U.S., according to a new HHS report.
By Rebecca Pifer • July 29, 2020 -
Permission granted by Heal
Humana invests $100M in at-home primary care startup Heal
"The fact that healthcare belongs in the home — there's an exclamation mark to it, because of the pandemic, but we believed it before," Heal CEO Nick Desai told Healthcare Dive.
By Rebecca Pifer • July 29, 2020 -
Samantha Liss/Healthcare Dive
Centene more than doubles Q2 profit amid pandemic
The results were aided by the COVID-19 crisis as medical use fell due to stay-at-home orders and patients delaying care, though the payer had slower enrollment gains as employers furlough workers instead of terminating them.
By Samantha Liss • July 28, 2020 -
CMS to begin recouping COVID-19 Medicare loans
Hospital groups have pleaded with the Trump administration and Congress to forgive the loans, or relax repayment terms, with no relief so far.
By Rebecca Pifer • July 27, 2020 -
Brian Tucker/Healthcare Dive
6 months in: The COVID-19 crisis
This series of stories examines how healthcare has changed during the course of the novel coronavirus in the United States, half a year after HHS declared a national public health emergency.
July 27, 2020 -
Skinny short-term plans deny coverage for pre-existing conditions: Commonwealth Fund
The analysis of more than 400 plans called junk by critics concluded few offer tangible benefits. The Trump administration backs short-term plans, arguing they're a low-cost alternative to broader coverage.
By Ron Shinkman • July 23, 2020
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