Price hikes drove employer-sponsored health costs to record high in 2018

The Health Care Cost Institute, drawing on data from Aetna, Humana, Kaiser Permanente and United Healthcare, found higher prices accounted for about three-quarters of the increase, while usage rose just about 3%.

By Hailey Mensik • Feb. 14, 2020

3 surprise billing proposals compared side by side

Congress advanced two proposals last week to ease unexpected medical bills as pressure mounts from consumers. Here are the key elements under consideration.

By Samantha Liss , Shannon Muchmore • Feb. 13, 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

CVS swings to $6.6B profit in 2019, buoyed by Aetna

The payer also saw growth in government services, reporting its Medicare Advantage business grew over three times the industry average in 2019, CEO Larry Merlo said Wednesday.

By Rebecca Pifer • Feb. 12, 2020

Payers saw medical cost ratios rise in Q4

As the country's major health insurers finished reporting their financial results from the fourth quarter of 2019 this week, a few themes emerged.

By Samantha Liss • Feb. 12, 2020

As SDOH efforts take off, payers try to carve out their role

Signify Community's Jamo Rubin said at a conference this week, "in four years of medical school and then residency, I never learned one thing about what happens to people after they get discharged."

By Rebecca Pifer • Feb. 12, 2020

Molina posts mixed Q4, says ACA shoppers not switching for savings

In an effort to drive greater membership in the marketplaces this year, the payer cut prices by 4% on average. But that didn't spur the growth hoped for in 2020, particularly in Texas and Florida.

By Samantha Liss • Feb. 11, 2020

1 in 5 surgery patients hit with surprise medical bill, JAMA study finds

Anesthesiologist and surgical assistants were associated with the most out-of-network charges. The findings come as lawmakers in Congress debate rival proposals to curb the unexpected bills this week.

By Hailey Mensik • Feb. 11, 2020

Kaiser income nearly triples to $7.4B in 2019, driven by investments

The results come as nonprofit healthcare operators across the country face rising scrutiny from regulators and lawmakers for what critics call excessive profits for a tax-exempt entity.

By Samantha Liss • Feb. 10, 2020

One Medical's CFO on why primary care is ripe for disruption

The company's IPO was for 17.5 million shares at $14, the low end of its range. On the listing day Jan. 31, shares jumped to about $20. Since then, the stock price has continued to rise.​

By Shannon Muchmore • Feb. 7, 2020

Azar touts 2019 greatest hits, glosses over setbacks in state of HHS speech

He skated over some high-profile efforts from the Trump administration that didn't bear fruit or sparked bad publicity last year, such as efforts to lower drug prices, Medicaid work requirements and cutting away at the ACA.

By Rebecca Pifer • Feb. 7, 2020

Rival surprise billing efforts jockey for attention in election year

Two new pieces of draft legislation, one from the House Ways and Means committee and another from the Education and Labor panel, were introduced Friday as Congress struggles to make headway on the issue.

By Rebecca Pifer • Updated Feb. 10, 2020

CMS proposes changes to Part D drug tiers, real-time benefit info for seniors

The proposed rule would also allow patients with end-stage renal disease to enroll in MA plans starting in 2021. Payer groups, however, voiced concerns about the change.

By Samantha Liss • Feb. 6, 2020

Cigna touts 2019 medical cost trend

CEO David Cordani defended the company's strategy to pursue partnerships with other players such as Prime Therapeutics and Oscar. "It's a dynamic marketplace and those who create the most value will win," he said.

By Samantha Liss • Feb. 6, 2020

Humana eyes doubling primary care membership, reports MA boost in Q4

Building off a new joint venture between a subsidiary and private equity firm, the payer said its primary care clinics still cover a "relatively small portion" of the overall Medicare Advantage business.

By Shannon Muchmore • Feb. 5, 2020

January price increases confirm slowing drug inflation

Payer and public pressure has led to slowing hikes, but more products are subject to increases, analysts say.

By Jonathan Gardner • Feb. 5, 2020

Lawmakers push for more oversight at CMS innovation center

A bipartisan group in the House introduced a bill that would require HHS to track how demonstration models impact patient access to care and potentially overhaul or eliminate those found to have adverse effects.

By Hailey Mensik • Feb. 5, 2020

Flu dampens Centene's Q4 medical loss ratio

CEO Michael Neidorff also weighed in on the Trump administration's proposal to partially reshape the Medicaid program into a block grant system, calling it a potential net positive for payers.

By Samantha Liss • Feb. 4, 2020

Humana expanding primary care centers through joint venture with PE firm

The payer and Welsh, Carson, Anderson & Stowe, which will have majority ownership, are making an initial commitment of about $600 million.

By Shannon Muchmore • Feb. 3, 2020

Payers, employers protest price transparency rule as wrong-headed

Most of the 23,355 public comments expressed skepticism or all-out opposition to the Trump administration's proposal targeting insurers.

By Samantha Liss • Jan. 31, 2020

The Trump administration is offering Medicaid block grants. Which states will say yes?

So far, the governors of Oklahoma and Arkansas have both expressed explicit support for the guidance allowing states to cap payments for adults who became eligible for Medicaid under the 2010 ACA expansion.

By Rebecca Pifer • Jan. 30, 2020

Codes for social determinants rarely used, analysis finds

The most frequently used code was for homelessness, followed by problems related to living alone and disappearance and death of a family member, according to CMS.

By Shannon Muchmore • Jan. 30, 2020

Trump admin to allow Medicaid caps, but legal fight likely as providers protest

Providers were quick to attack the highly anticipated plan giving states the option of accepting block grants for payment in the safety-net program, choosing between a per-enrollee or total coverage budget.

By Rebecca Pifer • Updated Jan. 30, 2020

Anthem beats earnings estimates but MLR disappoints

Operating revenue for the payer last year grew nearly 13% year over year to just above $103 billion. For the fourth quarter, it was up 16.4% to $27.1 billion, slightly above Wall Street expectations.

By Shannon Muchmore • Jan. 29, 2020

CMS widens NGS test coverage for inherited breast, ovarian cancers

While the agency declined to expand coverage beyond breast and ovarian, local Medicare contractors can make coverage determinations with other germline cancer diagnoses and on tests that have not been OK'd by FDA.

By Maria Rachal • Jan. 29, 2020

Pfizer poised to launch 3 biosimilars in coming months

The big pharma company, which has criticized others for stifling the U.S. biosimilars market, could have three cancer copycats on the market in the next three months.

By Jacob Bell • Jan. 29, 2020