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 Parduhn • 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

Shares in Oak Street Health soar 90% in market debut

Oak Street's IPO priced at $21 a share, but rose almost 90.5% in its first day of market trading Thursday, closing at $43.47.

By Shannon Muchmore • Updated Aug. 7, 2020

Democrats urge Trump administration to force full payer COVID-19 test coverage

The insurance lobby did not refute claims that not all testing is funded in full, particularly for return-to-work programs. Lawmakers said CMS guidance conflicts with legislation meant to spur widespread access to testing.

By Samantha Liss • July 8, 2020

Providence, Humana back ad campaign urging patients to stop 'medical distancing'

Since the pandemic's onset in the United States, health officials have been concerned about the consequences of routine and preventive care being delayed or put off entirely. Providers also fear continued revenue loss.

By Shannon Muchmore • July 8, 2020

Walmart jumps into health insurance market, including Medicare

Analysts said the move underscores the attractiveness of this market and the likelihood of increased competition over time, while the retail giant's reach has the potential to boost volume for Medicare plans.

By Hailey Mensik • July 8, 2020

Here are doctors' offices, hospitals that got COVID-19 paycheck protection loans over $150K

"Had we not gotten paycheck protection, with the decrease in patient volume we saw, we would have had to terminate employees," Beverly Jordan, a physician at a small rural practice in Enterprise, Alabama, told Healthcare Dive.

By Rebecca Pifer Parduhn • Updated July 8, 2020

Molina buys small New York Medicaid plan, executing on its strategy

The deal represents the payer's quest to use smaller acquisitions to propel its revenue and footprint.

By Samantha Liss • July 1, 2020

CVS reportedly creating group purchasing organization for PBM business

The goal of the GPO in the near term may be to shift discounts to less transparent fee structures that are harder for PBM customers to audit, allowing CVS to retain a greater share of rebate profits, according to a research report.

By Rebecca Pifer Parduhn • July 1, 2020

Oklahoma votes to expand Medicaid as COVID-19 surges in state

The vote was close, passing by less than one percentage point. The results throw a wrench into Republican hopes to cap Medicaid funding and follow ballot measures in other deep red states approving expansion.

By Rebecca Pifer Parduhn • July 1, 2020

DOJ charges execs, others with elaborate $1.4B billing scheme using rural hospitals

Ten defendants allegedly took over struggling rural hospitals and used them as a front to send fraudulent, pricey testing claims to commercial payers over more than two years, reaping $400 million in profits.

By Rebecca Pifer Parduhn • June 30, 2020

CMS wants to make home health telemedicine permanent

The Trump administration is also looking to change payment rates for home health providers that would increase Medicare payments by 2.6%, or roughly $540 million, for the 2021 calendar year.

By Rebecca Pifer Parduhn • June 26, 2020

North Carolina BCBS seeks to keep primary care practices afloat, nudge to value-based care

Participating doctor's offices will get added payments to stabilize flagging revenue for primary care services at their pre-COVID-19 levels beginning in September through 2021.

By Rebecca Pifer Parduhn • June 25, 2020

Short-term 'junk' plans widely discriminate against those with pre-existing conditions, House probe finds

An HHS spokesperson defended the coverage as an affordable option to pricier Affordable Care Act plans, telling Healthcare Dive, "We've been abundantly clear that these plans aren't for everyone." AHIP made similar points.

By Rebecca Pifer Parduhn • June 25, 2020

Payer coverage of employer, surveillance COVID-19 tests not required, feds say

As test offerings proliferate from lab and pharmacy giants like Quest, LabCorp and CVS, new federal guidance said health insurers aren't obligated to pay for return-to-work testing services.

By Maria Rachal • June 25, 2020

Medicare claims data for COVID-19 highlights stark racial, economic disparities

Fee-for-service payments for related hospitalizations totaled $1.9 billion for the first months of the pandemic, with Black Americans four times more likely to end up in the hospital from the coronavirus.

By Shannon Muchmore • June 23, 2020

Virtual care at a virtual conference: Telehealth will remain post-pandemic, experts say at AHIP

"If I were trying to be controversial, of course I'd say, 'No, it's going to go away.' But of course no one believes that," Google Health CMO Karen DeSalvo said. 

By Rebecca Pifer Parduhn • June 19, 2020

Medicaid insurers a growing competitive force in ACA marketplaces, report finds

Previous concerns about the managed care organizations' networks, pricing and impact on other insurers' participation have largely dissipated, according to the report from the Urban Institute and Robert Wood Johnson Foundation.

By Hailey Mensik • June 18, 2020

With new proposal, Trump administration tries to encourage 'value-based' drug deals

With an eye toward a coming wave of pricey gene therapies, CMS is seeking to make it easier for drugmakers and insurers to enter into contracts linking payment with patient outcomes.

By Ned Pagliarulo • June 18, 2020

Myriad prostate cancer test wins coverage from Aetna, other insurers

The decisions nearly double commercial coverage for the Prolaris test, days after a local Medicare contractor found there may be insufficient data to back Myriad's GeneSight combinatorial tests.

By Susan Kelly • June 17, 2020

COVID-19 crisis highlights health plans' increased need for expanded analytics and insights

Five ways analytics help solve some payer challenges brought on by COVID-19.

By Molly Gallaher Boddy, Geneia Strategy Planning Manager • June 17, 2020

MedPAC urges MA, ACO tweaks to speed up value-based payment reform

Medicare Advantage and ACOs could be vehicles for much needed value-based payment reform, but not without better aligned incentives and improved quality assessment, the advisory commission said.

By Shannon Muchmore • June 16, 2020

Hit with surprise COVID-19 test bill, lawmaker pushes Trump admin for guardrails to hold patients harmless

Insurers are generally required to cover the tests without cost-sharing under coronavirus relief legislation, yet patients across the country are still receiving bills, Katie Porter, D-Calif., said in a letter to key health officials.

By Rebecca Pifer Parduhn • June 15, 2020

FCC surpasses $100M in CARES telehealth funding approvals as House seeks more oversight

Top leadership in the House Energy and Commerce committee sent a letter Friday to the FCC requesting more transparency in the telehealth program, which passed the halfway mark in allocated funds earlier this week.

By Rebecca Pifer Parduhn • Updated June 12, 2020