Payer
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Permission granted by Elevance Health
Elevance notches $2.3B in profit, unfazed by Change attack
The insurer says it has caught up on claims delayed due to the cyberattack on the clearinghouse earlier this year, and shared more details on a new primary care venture with a private equity firm.
By Rebecca Pifer • April 17, 2024 -
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ACOs led by independent physicians save Medicare ‘substantially’ more money, CBO says
Independent practices have clearer financial incentives to lower medical spending than hospitals participating in accountable care organizations, according to the Congressional Budget Office.
By Rebecca Pifer • April 17, 2024 -
Explore the Trendline➔
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TrendlineSocial determinants of health
The focus on social determinants of health has only increased as the COVID-19 pandemic has devastated the United States.
By Healthcare Dive staff -
Permission granted by Elevance Health
Elevance partners with private equity firm on primary care
The payer has inked a deal with Clayton, Dubilier and Rice to join their primary care assets as Elevance looks to catch up with peers like UnitedHealth and CVS in care delivery.
By Rebecca Pifer • April 16, 2024 -
Courtesy of UnitedHealth Group
Change Healthcare cyberattackUnitedHealth expects up to $1.6B hit from Change cyberattack this year
Investors on Tuesday got a clearer picture of the cyberattack's financial fallout on the healthcare juggernaut. Some said it wasn't as bad as they'd feared.
By Rebecca Pifer • April 16, 2024 -
Kameleon007 via Getty Images
Florida issues Medicaid managed care awards booting out UnitedHealth, CVS and Molina
Meanwhile, Centene, Elevance and Humana held onto statewide contracts. The reprocurement was especially positive for Centene, which had been expected to lose market share, analysts said.
By Rebecca Pifer • April 15, 2024 -
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Medicaid redeterminationsMore than 20M disenrolled amid Medicaid redeterminations
Nearly a quarter of adults removed from the safety-net program since early last year said they are uninsured, according to KFF.
By Emily Olsen • April 12, 2024 -
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Confusion about Medicaid skewing coverage estimates, study finds
The number of people enrolled in Medicaid soared over the pandemic, but many enrollees may not have known their coverage had continued, new research suggests.
By Rebecca Pifer • April 10, 2024 -
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Michigan divvies out Medicaid contracts, with Centene, Molina seeing minor losses
However, the insurers could protest Michigan’s decision, potentially mitigating membership erosion.
By Rebecca Pifer • April 9, 2024 -
Alex Wong via Getty Images
CMS caps broker payments in Medicare Advantage
The final rule issued last week prevents insurers from paying brokers additional fees for steering beneficiaries to their plans.
By Rebecca Pifer • April 8, 2024 -
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Blue Shield of California and Providence at stalemate over contract negotiations
It's the latest negotiation to spill out of the boardroom and into the public eye as tensions between providers and payers ramp up.
By Susanna Vogel • April 3, 2024 -
Alex Wong / Staff via Getty Images
CMS finalizes ACA network adequacy rule
Starting in 2026, plans sold in state-based exchanges will be required to meet time and distance standards for provider access that are already applied to plans sold federally.
By Rebecca Pifer • April 3, 2024 -
Alex Wong / Staff via Getty Images
Biden administration finalizes modest cut to 2025 Medicare Advantage rates
Despite heavy lobbying, insurers failed to see MA rates improve in the final rule, which codified a 0.16% decrease to benchmark funding.
By Rebecca Pifer • April 2, 2024 -
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One year, 19M disenrollments: A look at Medicaid redeterminations so far
Threats of fines, procedural errors and more: Here are the major headlines from the past year of states unwinding Medicaid.
By Sydney Halleman • April 2, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth CFO John Rex to replace Dirk McMahon as president
McMahon announced earlier this year that he would retire from the healthcare behemoth in April. Rex will step up as president, though there’s no word yet on who will assume McMahon’s chief operating officer role.
By Rebecca Pifer • March 29, 2024 -
Mario Tama via Getty Images
Inside CVS Health’s push to transform customer experience
The transformation, led by Deloitte Digital, focused on increasing customer feedback to identify pervasive issues and closing the loop on customer inquiries.
By Kristen Doerer • March 29, 2024 -
Alex Wong / Staff via Getty Images
Biden administration finalizes rule cracking down on short-term plans
Democrat lawmakers and patient advocacy groups cheered the final rule for protecting patients from the skimpy plans, while free-market advocates slammed it as limiting coverage options for consumers.
By Rebecca Pifer • March 29, 2024 -
Alex Wong / Staff via Getty Images
CMS streamlines Medicaid, CHIP renewal and enrollment in final rule
It’s the “most robust and meaningful” regulation streamlining Medicaid eligibility since the Affordable Care Act was implemented a decade ago, one lawyer said.
By Rebecca Pifer • March 28, 2024 -
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Medicare’s GLP-1 spending is skyrocketing, even without weight loss coverage: KFF
Gross Medicare spending on the pricey drugs rose from $57 million in 2018 to $5.7 billion in 2022, according to a new analysis from the health policy group.
By Rebecca Pifer • March 27, 2024 -
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Medicare to cover Novo’s obesity drug for some patients
Two weeks after the FDA updated Wegovy’s label, Medicare changed its stance to allow people with a history of heart disease to receive treatment, a shift that could further boost access to the fast-selling medicine.
By Ben Fidler • March 22, 2024 -
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Hospitals could face revenue hit if insurers play hardball over MA: report
Insurers could increase claims denials and engage in aggressive contract negotiations with hospitals as profitability in the popular plans declines.
By Susanna Vogel • March 21, 2024 -
Alex Wong via Getty Images
CMS launches model to increase primary care investment in Medicare
Value-based care and physician interest groups said the model should create a more stable cash flow for providers.
By Rebecca Pifer • March 20, 2024 -
Courtesy of Kroger
Elevance to buy Kroger’s specialty pharmacy
Major pharmacy benefit managers continue to double down on specialty as a reliable source of business amid a growing crop of pharmacy upstarts.
By Rebecca Pifer • March 19, 2024 -
zimmytws via Getty Images
Government watchdog warns of Medicaid oversight gaps
The CMS doesn’t require states to report data on outcomes or care denials, and has made “delayed” progress on plans to analyze the information and make it public, according to the Government Accountability Office.
By Rebecca Pifer • March 18, 2024 -
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Continuous Medicaid enrollment linked to less postpartum coverage loss, study finds
States that have expanded Medicaid for a year after pregnancy might see similar coverage gains, researchers wrote.
By Emily Olsen • March 13, 2024 -
PeopleImages via Getty Images
Elevance completes Paragon Health acquisition
The infusion services and drug therapy company will operate under CarelonRx, Elevance’s pharmacy benefit manager.
By Susanna Vogel • March 11, 2024
