Payer: Page 69
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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 -
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 -
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 -
Opinion
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 -
Brian Tucker/Healthcare Dive
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
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