Payer: Page 68
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Ohio sues Centene, alleging PBM practices led to millions in overpayments
The payer called the claims "unfounded" in a statement, and said it planned to aggressively defend the integrity of its pharmacy services in Ohio.
By Rebecca Pifer Parduhn • March 12, 2021 -
Deep DiveHospitals lift curtain on prices, revealing giant swings in pricing by procedure
The eye-popping variations demonstrate "the total insanity of American healthcare pricing," Niall Brennan, CEO of the Health Care Cost Institute, said.
By Samantha Liss , Nami Sumida • March 11, 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 -
Alex Wong via Getty Images
CMS pushes back kidney care payment model start date to January 2022
It is the second Trump-era payment model President Joe Biden's health administration has recently tweaked.
By Rebecca Pifer Parduhn • March 10, 2021 -
Countering payers, drugmakers say net prices declined in 2020
Reports from three large pharmaceutical companies indicate increasing rebate payments and discounts to insurers more than offset the average price increases they took on their medicines.
By Jonathan Gardner • March 8, 2021 -
COVID-19 among top US telehealth diagnoses for first time
Mental health conditions continue to be the No. 1 telehealth diagnosis nationwide, according to new data from nonprofit Fair Health.
By Rebecca Pifer Parduhn • March 8, 2021 -
"Medical disposable masks on wooden background" by Marco Verch Professional Photographer and Speaker is licensed under CC BY 2.0
Becerra tells Californians to dispute COVID-19 fees from providers
Patients charged a "COVID fee" from a recent visit should contact their insurer and request a reimbursement, according to a statement from the state's attorney general, who is the nominee for HHS secretary.
By Hailey Mensik • March 4, 2021 -
Support for telehealth Medicare reimbursement gains steam in Congress
Tuesday's House committee mirrored similar Senate panels, in that a permanent expansion to a greater swath of the population enjoys bipartisan support, but legislators are split on what form it should take.
By Rebecca Pifer Parduhn • March 3, 2021 -
Hillrom steps back from $375M BardyDx deal on reimbursement setback
The hospital products maker said a Medicare contractor's unexpected drop in payment rates for BardyDx's cardiac monitoring technology meant closing conditions for the transaction had not been satisfied.
By Susan Kelly • March 1, 2021 -
National Institute of Allergy and Infectious Diseases. (2020). "Novel Coronavirus SARS-CoV-2" [Micrograph]. Retrieved from Flickr.
CMS moves to stop COVID-19 testing denials, cost sharing in private plans
Congress required comprehensive health plans to cover COVID-19 tests without cost sharing, prior authorization or medical management last year, only for guidance to create uncertainty about the rules.
By Nick Paul Taylor • March 1, 2021 -
Permission granted by Cigna
Cigna health services arm Evernorth completes buy of telehealth vendor MDLive
The deal closed Monday, the payer said. MDLive will operate as part of Evernorth's portfolio that also includes pharmacy benefit manager Express Scripts.
By Rebecca Pifer Parduhn • Updated April 20, 2021 -
Retrieved from The White House/YouTube on January 21, 2021
ACLA urges Biden to fund uninsured COVID-19 testing, close coverage loopholes
The plea from the trade group for Quest and LabCorp is the latest in a row between labs and insurers over paying for the diagnostics and comes as a $2 billion federal testing fund runs dry.
By Nick Paul Taylor • Feb. 24, 2021 -
SCOTUS drops Medicaid work requirement arguments at Biden administration's request
The administration is in the process of reversing the policy, which 12 states received federal approval to test. No such programs are currently active, having run into legal and administrative challenges even prior to the pandemic.
By Rebecca Pifer Parduhn • Updated March 11, 2021 -
Oscar Health eyes $6.7B valuation with upcoming IPO
Even though the startup added members to plans and expanded to several states last year, it faces flagging financial performance that could tamp down investor enthusiasm.
By Rebecca Pifer Parduhn • Feb. 22, 2021 -
Retrieved from Manatt on February 18, 2021
Obama admin alum Chiquita Brooks-LaSure picked to head CMS
Brooks-LaSure will have a lot on her plate. Biden during his campaign ran on expanding the role of the Affordable Care Act and perhaps attempting to build in a public option or lowered Medicare age eligibility.
By Shannon Muchmore • Updated Feb. 19, 2021 -
Anthem-backed digital startup Sharecare goes public in $3.9B blank check deal
The startup, launched by WebMD founder Jeff Arnold and medical TV personality Mehmet Oz, will merge with special purpose acquisition company Falcon Capital Acquisition and is the latest in the digital health SPAC craze.
By Rebecca Pifer Parduhn • Feb. 17, 2021 -
Payer profits nosedived in Q4 on increased COVID-19 expenses
Still, major insurers ended 2020 in the black, buoyed by the pullback in utilization during earlier quarters.
Feb. 17, 2021 -
Biden admin begins plan to rescind Medicaid work mandates in win for providers
The policies threatened to lower hospitals' Medicaid revenues as enrollees lost coverage, raising uncompensated care costs. But lawsuits and the pandemic have kept states from implementing the controversial Trump-era requirements.
By Samantha Liss • Feb. 16, 2021 -
CVS to jump back into individual ACA markets in 2022
The health giant has yet to disclose specific geographies or the cost of the plans, with newly installed CEO Karen Lynch telling investors Tuesday to expect more details in the second quarter.
By Rebecca Pifer Parduhn • Feb. 16, 2021 -
Molina expects utilization to remain depressed in 2021
Looking ahead, executives seemed cautiously optimistic for this year but noted headwinds from the COVID-19 pandemic will persist. Bright spots for the payer include the recently announced ACA special enrollment period.
By Samantha Liss • Feb. 11, 2021 -
As COVID-19 becomes a business, vaccine makers confront thorny pricing questions
Yearly vaccinations could be required after the pandemic ebbs. Will drugmakers change how they approach pricing their shots?
By Jonathan Gardner • Feb. 10, 2021 -
Medicare DME competitive bidding in doubt after failed round
Cowen analysts said a recent report found steep rate hikes, leading them to conclude the program is no longer such a big threat to companies like Baxter, ResMed and Philips.
By Nick Paul Taylor • Feb. 10, 2021 -
Centene to ax 3,000 jobs as run of profitable quarters ends
After months of benefiting from deferred care like many other insurers, Centene reported a loss in the fourth quarter in part due to higher COVID-19 testing and treatment costs.
By Samantha Liss • Feb. 9, 2021 -
Oklahoma selects 4 private payers to manage Medicaid for $2B, faces legal suit
The state maintains the switch will improve costs while maintaining access, but the move to cede Medicaid control to for-profit entities is highly controversial.
By Rebecca Pifer Parduhn • Feb. 9, 2021 -
Adeline Kon/Healthcare Dive
Fitch: Biden's healthcare plans could boost nonprofit hospitals
The ratings agency cited administration plans to bolster the Affordable Care Act, which could reverse the increased number of uninsured people, as among the factors driving brighter prospects.
By Ron Shinkman • Feb. 4, 2021 -
Cigna's COVID-19 costs outweighed deferred care savings for first time in Q4
CEO David Cordani told investors he expects 2021 to be a "year of transition" as coronavirus vaccine rollouts will "continue to tax an already overburdened healthcare system."
By Shannon Muchmore • Feb. 4, 2021
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