Payer: Page 7
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Stopping a ‘moral obscenity’: Senate Judiciary Committee expresses support for PBM reform
Sen. Chuck Grassley, R-Iowa, suggested Congress could once again move to overhaul PBMs’ controversial business practices after legislators pass President Donald Trump’s conservative megabill this summer.
By Rebecca Pifer • May 14, 2025 -
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CMMI revamps strategy to focus on disease prevention, cost savings
“Our system is facing unsustainable cost pressures,” said Director Abe Sutton. “We are pouring resources into treating disease after onset, rather than tackling the root causes and preventing it.”
By Emily Olsen • May 13, 2025 -
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 -
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Andrew Witty steps down as UnitedHealth CEO
Witty’s departure was surprising, though it follows a sharp downturn in the healthcare juggernaut’s financial outlook. He is being replaced by Stephen Hemsley, the chair of UnitedHealth’s board and a previous chief executive.
By Rebecca Pifer • May 13, 2025 -
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House Republicans unveil Medicaid cuts including work requirement, provider tax freeze
The House Energy and Commerce Committee is backing more moderate reforms to Medicaid. But Republicans’ policy proposals would still result in millions of Americans losing health insurance.
By Rebecca Pifer • May 12, 2025 -
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Millions could lose coverage under potential GOP Medicaid policies: CBO
The Congressional Budget Office expects states will replace about half of the reduced federal support with their own resources, and then reduce spending by cutting provider payment rates, optional benefits and enrollment.
By Emily Olsen • May 9, 2025 -
Emily Olsen/Healthcare Dive
Deep DiveMedicaid cuts could have ‘drastic impact’ on providers
Some providers may need to reduce services, lay off staff or close their doors if Congress enacts major cuts to the safety-net insurance program, experts say.
By Emily Olsen • May 9, 2025 -
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Democrats urge Republicans to focus on Medicare Advantage upcoding instead of Medicaid cuts
Stopping MA insurers from inflating their reimbursement is a better strategy to save federal dollars than restricting benefits or cutting eligibility in Medicaid, the Democrat lawmakers wrote to GOP leadership.
By Rebecca Pifer • May 9, 2025 -
Courtesy of UnitedHealth Group
Shareholders sue UnitedHealth for obfuscating business impacts from Thompson death
The lawsuit, which seeks class action status, alleges that UnitedHealth and its executives didn’t properly warn investors about how the killing of UnitedHealthcare CEO Brian Thompson would affect its business.
By Rebecca Pifer • May 8, 2025 -
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Health insurers see signs of life in Q1
Payer profits fell in 2024 as Americans, especially older ones, utilized more medical care. But efforts to resuscitate margins appear to be working for most — at least for now, according to first quarter results.
By Rebecca Pifer • May 7, 2025 -
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UnitedHealth, Amedisys reach new deal to sell home health and hospice locations if merger approved
The sales are contingent on the closure of UnitedHealth’s acquisition of Amedisys, which has been held up after the Department of Justice sued to block the deal last year.
By Emily Olsen • May 6, 2025 -
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Trump releases 2026 budget including heavy healthcare cuts
White House officials say the budget, which would slash the HHS’ discretionary funding by 26%, is necessary to curb government bloat. Medical groups say it amounts to an attack on biomedical funding and public health.
By Rebecca Pifer • May 5, 2025 -
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Sponsored by Quest DiagnosticsMind the gap: How lab partners can help Part C plans adapt to Medicare Star Rating changes
A 1-star boost in Medicare ratings can add up to $16.2M in revenue and 8–12% enrollment growth.
May 5, 2025 -
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Cigna doubles down on GLP-1 support programs with 2 new launches
On Friday, the company’s health services unit Evernorth unveiled new programs in a reliable growth area: helping payers manage GLP-1 utilization. Cigna also posted first quarter results well above analyst forecasts.
By Rebecca Pifer • May 2, 2025 -
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DOJ accuses CVS, Humana, Elevance of paying kickbacks to Medicare Advantage brokers
According to the complaint, the insurers paid brokers eHealth, GoHealth and SelectQuote hundreds of millions of dollars for enrolling seniors in their MA coverage — regardless of the plans’ suitability for those members’ needs.
By Rebecca Pifer • Updated May 2, 2025 -
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CVS plans to exit ACA individual exchanges, strikes Wegovy deal with Novo Nordisk
Aetna is once again retreating from the Affordable Care Act market, while its parent company notched a deal with Danish drugmaker Novo Nordisk that should expand access to its in-demand GLP-1 at the expense of Eli Lilly’s.
By Rebecca Pifer • May 1, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth names new CEO of Optum
Patrick Conway will replace Heather Cianfrocco, who is being promoted to UnitedHealth’s executive vice president of governance, compliance and information security, the company announced Tuesday.
By Rebecca Pifer • April 30, 2025 -
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Republican lawmakers urge CMMI to focus on cost savings, transparency
Lawmakers on the House Ways and Means Committee also accused CMMI of promoting “a political agenda,” like focusing on health equity and minimizing the importance of cost savings.
By Emily Olsen • April 30, 2025 -
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Humana posts ‘really good’ first quarter on stable medical costs
Despite the outperformance, the payer’s stock was largely flat following the earnings release — a market reaction that reflects the uncertainty facing Humana.
By Rebecca Pifer • April 30, 2025 -
Julia Rendleman via Getty Images
Cigna CIO departs to lead tech, operations group at UK bank
Noelle Eder resigned earlier this month, marking the latest in a string of recent C-suite changes at the healthcare company.
By Roberto Torres • April 29, 2025 -
Kevin Dietsch/Getty Images via Getty Images
TrackerThe Trump administration is overhauling healthcare policy. Follow the changes here.
The FDA said it’s sending letters to drugmakers demanding they take down or modify ads that don't comply with federal guidelines, out of concern consumers aren’t seeing a “fair balance” of risks and benefits in drug ads.
By Healthcare Dive staff • Updated Sept. 10, 2025 -
Samantha Liss/Healthcare Dive
Centene raises outlook for revenue — and costs — in 2025
Centene’s first-quarter results didn’t appear to quell investor concerns about volatility in the health insurance market.
By Rebecca Pifer • Updated April 25, 2025 -
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Blue Shield of California exposed data of 4.7M people to Google
The insurer learned that Google Analytics shared member data with its advertising service from April 2021 through January 2024.
By Emily Olsen • April 24, 2025 -
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Molina reports mixed Q1, says Medicaid rates are increasing
The California-based insurer’s results were “good enough,” one analyst said.
By Rebecca Pifer • April 24, 2025 -
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CMS may be angling to reform Medicaid state directed payments
A new regulation pending in front of the Office of Management and Budget suggests the Trump administration may be moving to overhaul the controversial financing mechanism.
By Rebecca Pifer • April 23, 2025 -
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Elevance brushes off fears of spiking Medicare Advantage costs
Investors balked last week after UnitedHealth reported first-quarter MA utilization grew at twice its expected rate. Yet Elevance said spending was in line with expectations, a development one analyst called surprising.
By Rebecca Pifer • April 22, 2025
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