Payer: Page 3
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Molina loses Medicaid contract in Virginia
It’s the second recent Medicaid state loss for Molina, despite executives expressing confidence about the insurer’s ability to retain contracts.
By Rebecca Pifer • March 1, 2024 -
Permission granted by Elevance Health
Elevance launches weight management program, including GLP-1 monitoring
Elevance joins a growing list of insurers expanding their weight management offerings amid soaring demand for GLP-1 drugs.
By Sydney Halleman • Feb. 28, 2024 -
Explore the Trendline➔
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TrendlineSocial determinants of health
The focus on social determinants of health has only increased because of the impacts of the pandemic, with payers and providers trying to new ways to address the issues.
By Healthcare Dive staff -
Courtesy of UnitedHealth Group
UnitedHealth under antitrust investigation by DOJ: reports
Regulators are reportedly looking into the massive healthcare conglomerate’s potential anticompetitive effects, including the relationship between its health insurer UnitedHealthcare and physician network Optum.
By Rebecca Pifer • Feb. 28, 2024 -
Alex Wong via Getty Images
Lobby-funded study argues Medicare Advantage rate cuts are worse than CMS expects
Medicare Advantage payment per month per beneficiary could drop by 1% next year if regulators finalize rates as proposed, according to the analysis backed by the Better Medicare Alliance.
By Rebecca Pifer • Feb. 27, 2024 -
Colin Campbell/Healthcare Dive
State attorneys general urge PBM reform
The letter, sent on behalf of 39 state attorneys general to leaders in Congress, comes as lawmakers consider legislation to regulate the pharmacy middlemen.
By Sydney Halleman • Feb. 23, 2024 -
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Medicare Advantage plans provide less intensive post-acute care, study finds
The research found no differences in 30-day hospital readmissions or mortality, but the study’s authors said more analysis on patients’ long-term functioning was needed.
By Emily Olsen • Feb. 21, 2024 -
Alex Wong via Getty Images
CMS finalizes rule to cut Medicaid DSH payments for some hospitals
Under the new definition, hospitals can only receive disproportionate share hospital Medicaid reimbursements for beneficiaries who are primarily insured by the safety-net program.
By Susanna Vogel • Updated Feb. 22, 2024 -
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No Surprises implementation created uptick in in-network claims: Fair Health
From the fourth quarter of 2021 to the first quarter of 2022, in-network care as a percentage of all national claim lines increased 2.3%, the nonprofit found.
By Rebecca Pifer • Feb. 20, 2024 -
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Deep DiveInsurers brace for continued Medicare Advantage medical costs
The big question coming out of the health insurance earnings season is how much elevated utilization among seniors is carrying over into 2024.
By Rebecca Pifer • Feb. 20, 2024 -
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Disputes over surprise billing continue to soar, new CMS data shows
Arbiters are mostly selecting the higher payment offer in billing dispute determinations. That suggests No Surprises could actually raise premiums for consumers, one health researcher said.
By Rebecca Pifer • Feb. 16, 2024 -
CFO Editorial Staff
SCAN Group, CareOregon abandon merger plans
The insurers have dissolved their merger a little over a year after it was announced amid rising criticism from politicians and the public.
By Susanna Vogel • Feb. 15, 2024 -
Permission granted by Elevance Health
Blue Cross of Louisiana halts sale to Elevance
It's the latest setback for the $2.5 billion deal, which was proposed early last year but has struggled to close amid a lack of buy-in from state regulators.
By Rebecca Pifer • Feb. 15, 2024 -
erdikocak via Getty Images
Private equity deals in Medicare Advantage decline, report finds
High interest rates and new regulations could be driving the slowdown, according to a report by the Private Equity Stakeholder Project.
By Emily Olsen • Feb. 14, 2024 -
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Humana sued over alleged 340B underpayments in Medicare Advantage
Alabama-based Baptist Health argued the insurer had received a “windfall” due to illegal payment cuts in the 340B drug discount program.
By Emily Olsen • Feb. 13, 2024 -
Permission granted by Elevance Health
Elevance lays off more employees
The health insurer has quietly laid off thousands of employees since September, according to sources.
By Rebecca Pifer • Feb. 13, 2024 -
RiverNorthPhotography via Getty Images
FTC obtains $195M judgment against Simple Health for selling ‘sham’ insurance
The Florida-based insurer deceived tens of thousands of consumers into purchasing what they believed was comprehensive coverage, but instead amounted to a medical discount membership.
By Rebecca Pifer • Feb. 12, 2024 -
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Molina’s redeterminations losses reach 500K members
As for Medicare Advantage, the insurer said it expects proposed 2025 rates other payers have slammed as a cut would actually boost its benchmark rate.
By Rebecca Pifer • Feb. 8, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth COO Dirk McMahon to retire
McMahon is leaving after two decades at the insurer.
By Rebecca Pifer • Feb. 8, 2024 -
Justin Sullivan via Getty Images
CVS cuts 2024 outlook on Medicare Advantage caution
The insurer on Wednesday joined its peers in slamming proposed MA payment rates as insufficient given the dogged increase in medical costs.
By Rebecca Pifer • Feb. 7, 2024 -
Gerenme via Getty Images
AHA calls for more payer oversight in No Surprises dispute resolution
In comments on a proposed rule, the American Hospital Association argued regulators haven’t fully addressed how they’ll handle oversight for some situations, like when an insurer fails to pay after a dispute determination.
By Emily Olsen • Feb. 7, 2024 -
Samantha Liss/Healthcare Dive
Centene echoes Humana’s concerns about proposed MA rate drop
On the insurer’s earnings call, analysts peppered Centene with questions about its Medicare Advantage business until its CFO attempted to change the subject.
By Rebecca Pifer • Feb. 6, 2024 -
Leonardo Fernandez Viloria/Getty Images via Getty Images
Q&ABeMe’s CEO Nicki Tessler on digital behavioral health programs and payer partnerships
Depression and anxiety climbed among teens during the COVID-19 pandemic. Nicki Tessler, CEO and cofounder of BeMe Health, breaks down solutions.
By Brian T. Horowitz • Feb. 5, 2024 -
Alex Wong / Staff via Getty Images
Humana flags potential MA funding dip if proposed rate notice finalized
Despite the uncertainty, the insurer reaffirmed its earnings outlook for 2025.
By Rebecca Pifer • Feb. 5, 2024 -
Julia Rendleman via Getty Images
Cigna is still interested in Medicare
The health insurer sees Medicare Advantage as an area for future growth, despite selling the division for $3.7 billion. Cigna’s CEO called the sale a “win-win” on a call with investors Friday.
By Rebecca Pifer • Feb. 2, 2024 -
Spencer Platt via Getty Images
Medicare Advantage plans could see rates dip slightly in 2025
The CMS proposed a 0.2% dip in MA rates. However, analysts said regulators will likely improve the payment rate in the final notice.
By Rebecca Pifer • Feb. 1, 2024
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