Payer: Page
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Surprise Billing
Congress, alongside provider and consumer groups, continues spat over surprise billing ban rules
While payers and providers must start complying with the No Surprises Act by Jan. 1, the fight over rules implementing the ban is heating up as provider groups object to what they think is a favoring of insurers.
By Hailey Mensik • Nov. 17, 2021 -
Opinion
Congress: Target the middlemen who drive up drug costs
"The PBM market lacks the three elements essential for competition — choice, transparency and a lack of conflict of interest," antitrust attorney and former FTC policy director David Balto argues.
By David Balto • Nov. 15, 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 -
Biogen's pricey Alzheimer's drug contributes to major Medicare premium hikes
The 15% jump in Part B premiums for 2022 is a case study in how just one expensive medication can affect the spending of millions in the U.S.
By Rebecca Pifer Parduhn • Nov. 15, 2021 -
Permission for use provided by Zelis
Sponsored by ZelisZelis helps address new NSA and TiC regulations
Learn more about innovative solutions that can help you comply with new regulations.
Nov. 15, 2021 -
Family premiums rise as employers boost virtual, mental health benefits, KFF finds
About half of employers with at least 200 workers reported healthcare utilization among their plan enrollees was in line with expectations for the most recent quarter, while 32% said it was below estimates.
By Hailey Mensik • Nov. 11, 2021 -
Anthem plans to buy Integra Managed Care in New York
The acquisition expands the payer's Medicaid business, a service line that has experienced major growth over the past year.
By Samantha Liss • Nov. 10, 2021 -
Health centers raise alarm about rolling back Medicaid coverage post-public health emergency
The clinics are worried about people with Medicaid coverage being deemed ineligible and losing insurance once states revert back to pre-pandemic Medicaid policies and eligibility, a new survey found.
By Rebecca Pifer Parduhn • Nov. 10, 2021 -
Oak Street faces DOJ inquiry into third-party marketing, transportation relationships
Analysts said the inquiry, while in early stages, could pressure the company's stock. "This creates a new potential risk factor that we are unlikely to get clarity on for some time," SVB Leerink analyst Whit Mayo said.
By Rebecca Pifer Parduhn • Nov. 9, 2021 -
Kaiser's operating margin dwindles as COVID-19 expenses, labor costs rise
Along with ongoing pandemic stresses, the California nonprofit is facing rising expenses amid intense workforce pressure as it faces the start of a major strike next week.
By Rebecca Pifer Parduhn • Nov. 8, 2021 -
Insurer profitability remained strong in Q3 despite unexpectedly high COVID-19 costs
For most payers, higher-than-expected coronavirus costs were offset by patients continuing to delay nonessential medical care.
Nov. 5, 2021 -
Julia Rendleman via Getty Images
Cigna reports special enrollment period led to bump in medical claims, still posts $1.6B profit
Analysts characterized the third quarter results as mixed, even as the payer hiked its forecast for the remainder of the year.
By Samantha Liss • Nov. 4, 2021 -
Controversial UnitedHealth-Change tie-up gets new deadline for DOJ review
Consummation of UnitedHealth's $13 billion Change acquisition is now teed up for February at the earliest, though the deal could close even sooner if the DOJ unexpectedly drops its investigation — or later, if the agency challenges.
By Rebecca Pifer Parduhn • Nov. 4, 2021 -
Courtesy of Humana
Humana cuts outlook after delta surge raises utilization expectations
Hospitalization trends were on par with January 2021, the height of the pandemic. As a result, Humana expects utilization to run higher than its original forecast, cutting into earnings expectations for the full year.
By Samantha Liss • Nov. 3, 2021 -
Alex Wong via Getty Images
CMS finalizes plans to hike price transparency penalties, extend telehealth flexibilities
The agency is also moving forward with a plan to stop the elimination of the Medicare inpatient-only list, which is a win for hospitals.
By Shannon Muchmore • Nov. 3, 2021 -
COVID-19 medical costs drag Aetna's commercial business, but CVS still posts $1.6B in Q3 profit
Though the pandemic continues to stress CVS' payer segment, drugstores continue to benefit from COVID-19 testing and vaccinations, particularly as a greater number of employers begin to mandate the shots.
By Rebecca Pifer Parduhn • Nov. 3, 2021 -
Alex Wong via Getty Images
Outset nabs first CMS home dialysis add-on payment, setting up fight with Fresenius
The company, whose application was rejected last year, persuaded the Medicare agency its portable dialysis machine is a "substantial clinical improvement" over the incumbent home-use hemodialysis product.
By Nick Paul Taylor • Nov. 3, 2021 -
Adeline Kon/Healthcare Dive/Healthcare Dive
Deep DiveWhy are women more likely to use telehealth?
As Washington mulls over telehealth regulations post-COVID-19, it's important not to roll back access in a way that could disproportionately affect women, experts say.
By Rebecca Pifer Parduhn • Nov. 2, 2021 -
Federal data shows ACA, Medicaid coverage kept uninsured rate steady as open enrollment kicks off
And the numbers suggest ACA and Medicaid enrollment may be continuing the momentum notched last year as consumers turned to the programs in droves after losing job-based coverage.
By Rebecca Pifer Parduhn • Nov. 1, 2021 -
Permission granted by LaneTerralever
Sponsored by LaneTerraleverWhat elective healthcare can teach us about the future of patient experience
A new report exploring how elective procedure patients think and feel can give us insight into the changes that providers and networks must make to ensure their patients feel connected during each phase of their journey.
Nov. 1, 2021 -
Delta surge weighs on Molina's Q3 earnings, but membership up 20%
Despite pandemic pressure, the insurer largely beat Wall Street expectations, and Jefferies analysts said the company delivered "solid overall results."
By Samantha Liss • Oct. 28, 2021 -
Adeline Kon/Healthcare Dive
Deep DiveA look at Teladoc's primary care strategy from its head of US group health
In an interview, Kelly Bliss teased upcoming clients for a new virtual-first primary care product and parsed out Teladoc's growth strategies for 2022 and beyond.
By Rebecca Pifer Parduhn • Oct. 27, 2021 -
Samantha Liss/Healthcare Dive
Centene looks to sell non-core assets, bounces back from Q2 loss
The insurer rebounded in the third quarter as patient utilization returned to more normal levels and revenue increased 11% year over year.
By Samantha Liss • Oct. 26, 2021 -
Julia Rendleman via Getty Images
Cigna expands telehealth benefits for employer-covered lives, including new virtual-first plan
The virtual-first plans will initially be available to large, self-insured employers, though the insurer is looking to expand to smaller sized and fully insured clients over time.
By Rebecca Pifer Parduhn • Oct. 26, 2021 -
Large purchaser coalition PBGH forms new venture to lower employer health costs, starting with PBM launch
Emsana is the latest independent venture from employer interests looking to disrupt the healthcare industry, a task easier said than done.
By Rebecca Pifer Parduhn • Oct. 25, 2021 -
CMMI wants every Medicare beneficiary in an accountable care plan by 2030
Officials acknowledged provider concerns that current models are too burdensome and benchmarks too complex, which the innovation center aims to fix.
By Hailey Mensik • Oct. 21, 2021
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