Neither Anthem nor Cigna win damages in 'corporate soap opera' merger fight

The two payers "must deal independently with the consequences of their costly and ill-fated attempt" at a $54 billion union that ultimately failed, a court ruled.

By Samantha Liss • Sept. 1, 2020

Aetna unveils plan nudging members to CVS clinics, pharmacies

David Balto, former policy director of the FTC, said the plan design would result in less choice and higher costs, and that with it "CVS is moving toward a restricted market approach that would only be attractive in the Soviet Union."

By Rebecca Pifer Parduhn • Updated Sept. 1, 2020

Allina, Minnesota Blues enter into sweeping value-based pact

The payer and provider aim to cut the cost trend for care by 10% over the next five years through the multiyear agreement, which will cover about 130,000 people.

By Ron Shinkman • Aug. 28, 2020

COVID-19 insurance crisis may not be as drastic as initially feared: study

A comparative analysis conducted by the Urban Institute found studies attempting to quantify how COVID-19 has affected the country's job-based insurance landscape differ wildly on methodology and conclusions.

By Rebecca Pifer Parduhn • Aug. 28, 2020

Aetna faces $500,000 fine over denying ER claims after repeated violations in California

A state regulator has ordered Aetna to cease and desist its practice of withholding reimbursement for emergency care.

By Samantha Liss • Aug. 27, 2020

MA encounter data lack essential information for fraud protection: OIG report

Medicare Advantage organizations, which cover a third of Medicare beneficiaries, already collect some of the information, but most don't submit it to CMS because it's not a requirement.

By Hailey Mensik • Aug. 26, 2020

Aetna turns to WellBe Senior Medical to deliver at-home care to high-risk seniors

The partnership allows the payer to tightly manage a group of patients that are likely to be more costly — seniors with multiple complex health conditions — by keeping them out of higher-cost settings like a hospital.

By Samantha Liss • Aug. 26, 2020

Louisiana health department wants Medicaid contract search do-over

Centene and Aetna filed protests when they were not awarded the lucrative contracts last year, and an investigation determined the awarding process was "fatally flawed." A new bidding process could end the dispute.

By Hailey Mensik • Aug. 24, 2020

Many COVID-19 cost-sharing waivers set to expire by October: study

The Kaiser Family Foundation report raises concerns more privately insured individuals could soon be exposed to steep medical costs at a time of deep economic and public health instability, even as payers report record profits.

By Rebecca Pifer Parduhn • Aug. 21, 2020

Uber Health forays into prescription drug delivery

The rideshare company is angling for a slice of the lucrative U.S. prescription drug market through a partnership with on-demand prescription delivery platform NimbleRx.

By Rebecca Pifer Parduhn • Aug. 20, 2020

Lyft claims NEMT program helps Medicaid beneficiary health access

The ridehailing giant and chief rival Uber have touted the efficacy of their non-emergency medical transportation programs, but traditional transportation brokers say they can't meet the niche needs of many U.S. patients.

By Rebecca Pifer Parduhn • Aug. 19, 2020

Threat of financial loss main barrier to value-based model adoption: exec poll

The survey from consultancy Numerof & Associates found the healthcare industry generally supports alternate payment models, but is still falling short of actually tying reimbursement to value.

By Rebecca Pifer Parduhn • Aug. 19, 2020

Cleveland Clinic, Aetna team up on insurance plan, ACO

A nationwide part of the initiative will offer the payer's commercial plan members access to virtual second opinion services from Cleveland Clinic providers. They are also creating a Cardiac Center of Excellence program.

By Shannon Muchmore • Aug. 19, 2020

Two-fifths of working-age adults lacked reliable insurance in first half of 2020, Commonwealth Fund says

People of color disproportionately lacked comprehensive coverage and were more likely to struggle financially with medical bills, the report found.

By Rebecca Pifer Parduhn • Aug. 19, 2020

Employers expect to boost virtual care offerings, survey finds

Business Group on Health's annual survey also found roughly 80% of respondents believe telehealth will play a significant role in how care is delivered in the future, up from 64% in 2019 and 52% in 2018.

By Hailey Mensik • Aug. 18, 2020

Cigna taps former Hilton exec as global CIO

Noelle Eder last held the role of EVP and chief information and digital officer at Hilton Worldwide Holdings. Prior to that, she held leadership roles at Capital One and Intuit.

By Roberto Torres • Aug. 17, 2020

Payers win again, court rules Trump admin violated law in axing ACA cost-sharing payments

Judges said, however, that insurers able to raise premiums to offset the loss of the payments in 2018 should not receive the entire unpaid amount.

By Shannon Muchmore • Aug. 14, 2020

Oklahoma pulls Medicaid block grant application

The move comes after the state's voters narrowly approved Medicaid expansion last month and is a blow to the Trump administration's attempt to overhaul the program with block grants, long a conservative policy goal.

By Hailey Mensik • Aug. 14, 2020

As Congress eyes an inquiry into insurer profits, experts caution they may not last

"One thing that we can be certain of is that the lower level of claims cost experienced in the second quarter will not continue indefinitely," Bradley Ellis, senior director of North American insurance ratings for Fitch Ratings, said.

By Samantha Liss • Aug. 12, 2020

Biden VP pick Harris, early backer of 'Medicare for All,' later pivoted

Among the largest donors to Sen. Kamala Harris' primary run were workers, owners and political action committees associated with healthcare powerhouse Kaiser Permanente.

By Shannon Muchmore • Aug. 12, 2020

20 state AGs urge Trump admin to nix proposed tax breaks for health sharing ministries

Saying it would undermine the Affordable Care Act and encourage fraud, the attorneys general called a draft rule arbitrary and particularly dangerous amid the COVID-19 pandemic.

By Ron Shinkman • Aug. 12, 2020

Trump tries to revamp drug supply chain with latest order

A directive announced by the president Thursday would require government agencies to buy certain "essential" drugs from factories in the U.S. How easily such an order would be implemented isn't clear.

By Ben Fidler • Aug. 7, 2020

Payers saw massive Q2 profits as COVID-19 deferred care

Anthem, UnitedHealth and Centene reported at least doubling profits for the quarter. Meanwhile, CVS-owned Aetna and Humana raised their 2020 earnings outlooks.

By Shannon Muchmore • Aug. 7, 2020

DOJ sues Cigna, alleging $1.4B in Medicare Advantage fraud

The payer used a medical assessment program to find health conditions that could raise risk scores of plan members, offering incentives to physicians who gave the exam, according to the lawsuit.

By Hailey Mensik • Aug. 6, 2020

Fresh off Medicaid win in Missouri, Fairness Project calls for health industry to step up

"We need to see health insurers and private hospitals step up and make massive investments in these campaigns," Jonathan Schleifer, executive director of the D.C.-based advocacy group, told Healthcare Dive.

By Samantha Liss • Aug. 6, 2020