Why COVID-19's biggest impact on healthcare may not be until 2022

This perfect storm of a shift in payer mix, the impending insolvency of Medicare and the inability of states to absorb the growing costs of Medicaid represent a tsunami of challenges, former VA Secretary David Shulkin writes.

By David Shulkin • July 23, 2020

M&A volume in health services for H1 was lowest since 2015, PwC finds

The subsector with the most deals in terms of volume was long-term care, continuing a trend since 2014, followed by other services, physician medical groups, hospitals and home health, according to the analysis.

By Shannon Muchmore • July 23, 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

Coronavirus vaccine developers make case to Congress they can win public's trust

While developing a safe and effective vaccine remains the chief challenge, lawmakers grilled pharma officials on how any successful shot would be fairly priced and distributed.

By Ben Fidler • July 22, 2020

UnitedHealthcare gets lowest grades in Leapfrog poll, average plan gets C+

The biggest commercial payer got the lowest satisfaction ratings on moving toward cost and quality and also the lowest GPA, the new survey of more than 170 employers found.

By Rebecca Pifer • July 22, 2020

Direct primary care backers hope COVID-19 entices docs to alternate payment model

Some practices using the model, where patients pay a flat fee with no insurance accepted, say their finances have been relatively unchanged since the start of the pandemic.

By Rebecca Pifer • July 21, 2020

Molina acquires Kentucky's second-largest Medicaid plan for $20M

The payer closed the deal this week and now covers about 315,000 more Medicaid members in the state.

By Samantha Liss • Updated Sept. 1, 2020

Appeals court upholds Trump admin's expansion of short-term health plans

The Association of Community Affiliated Plans said it would appeal Friday's decision, slamming the bare-bones plans — which sparked a yearlong Democrat committee investigation — as "junk insurance."

By Rebecca Pifer • July 17, 2020

Express Scripts faces lawsuit alleging it overcharged Ohio public pension fund

"We want our money back," AG Dave Yost said in a statement, contending the PBM "egregiously charged for services it didn't deliver." It's the latest action by the state cracking down on pharmacy benefit managers.

By Samantha Liss • July 15, 2020

10M could lose employer-sponsored healthcare as COVID-19 spurs job losses

Higher percentages of people losing their employer insurance will become uninsured in states that did not expand Medicaid eligibility under the ACA, according to the new study.

By Hailey Mensik • July 15, 2020

UnitedHealth doubles profit in Q2 as MLR plummets to 70.2% amid pandemic

CEO David Wichmann pushed back against proposals for a Medicare-like public option, noting: "We believe there's a near-universal coverage system in America today," despite rampant loss of insurance during the crisis.

By Rebecca Pifer • July 15, 2020

COVID-19 hospital charges vary widely by age, Fair Health study finds

The most common venue for an initial diagnosis was a doctor's office. About 33% of patients sought help from an office, while 23% went to an inpatient facility, such as an ER, according to the analysis of insurance claims.

By Hailey Mensik • July 14, 2020

Trump admin seeks relaxed grandfathered ACA health plan rules that up out-of-pocket costs

The proposed rule acknowledged that changes could lead to higher deductibles and other costs for an estimated 23.1 million enrollees in such plans and lead to more people foregoing healthcare.

By Ron Shinkman • July 13, 2020

Shares in Oak Street Health soar 90% in market debut

Oak Street's IPO priced at $21 a share, but rose almost 90.5% in its first day of market trading Thursday, closing at $43.47.

By Shannon Muchmore • Updated Aug. 7, 2020

Democrats urge Trump administration to force full payer COVID-19 test coverage

The insurance lobby did not refute claims that not all testing is funded in full, particularly for return-to-work programs. Lawmakers said CMS guidance conflicts with legislation meant to spur widespread access to testing.

By Samantha Liss • July 8, 2020

Providence, Humana back ad campaign urging patients to stop 'medical distancing'

Since the pandemic's onset in the United States, health officials have been concerned about the consequences of routine and preventive care being delayed or put off entirely. Providers also fear continued revenue loss.

By Shannon Muchmore • July 8, 2020

Walmart jumps into health insurance market, including Medicare

Analysts said the move underscores the attractiveness of this market and the likelihood of increased competition over time, while the retail giant's reach has the potential to boost volume for Medicare plans.

By Hailey Mensik • July 8, 2020

Here are doctors' offices, hospitals that got COVID-19 paycheck protection loans over $150K

"Had we not gotten paycheck protection, with the decrease in patient volume we saw, we would have had to terminate employees," Beverly Jordan, a physician at a small rural practice in Enterprise, Alabama, told Healthcare Dive.

By Rebecca Pifer • Updated July 8, 2020

Molina buys small New York Medicaid plan, executing on its strategy

The deal represents the payer's quest to use smaller acquisitions to propel its revenue and footprint.

By Samantha Liss • July 1, 2020

CVS reportedly creating group purchasing organization for PBM business

The goal of the GPO in the near term may be to shift discounts to less transparent fee structures that are harder for PBM customers to audit, allowing CVS to retain a greater share of rebate profits, according to a research report.

By Rebecca Pifer • July 1, 2020

Oklahoma votes to expand Medicaid as COVID-19 surges in state

The vote was close, passing by less than one percentage point. The results throw a wrench into Republican hopes to cap Medicaid funding and follow ballot measures in other deep red states approving expansion.

By Rebecca Pifer • July 1, 2020

DOJ charges execs, others with elaborate $1.4B billing scheme using rural hospitals

Ten defendants allegedly took over struggling rural hospitals and used them as a front to send fraudulent, pricey testing claims to commercial payers over more than two years, reaping $400 million in profits.

By Rebecca Pifer • June 30, 2020

CMS wants to make home health telemedicine permanent

The Trump administration is also looking to change payment rates for home health providers that would increase Medicare payments by 2.6%, or roughly $540 million, for the 2021 calendar year.

By Rebecca Pifer • June 26, 2020

North Carolina BCBS seeks to keep primary care practices afloat, nudge to value-based care

Participating doctor's offices will get added payments to stabilize flagging revenue for primary care services at their pre-COVID-19 levels beginning in September through 2021.

By Rebecca Pifer • June 25, 2020

Short-term 'junk' plans widely discriminate against those with pre-existing conditions, House probe finds

An HHS spokesperson defended the coverage as an affordable option to pricier Affordable Care Act plans, telling Healthcare Dive, "We've been abundantly clear that these plans aren't for everyone." AHIP made similar points.

By Rebecca Pifer • June 25, 2020

Payer coverage of employer, surveillance COVID-19 tests not required, feds say

As test offerings proliferate from lab and pharmacy giants like Quest, LabCorp and CVS, new federal guidance said health insurers aren't obligated to pay for return-to-work testing services.

By Maria Rachal • June 25, 2020