Payer
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Kansas jilts CVS in new Medicaid contract awards
Kansas kicked CVS to the curb in favor of an Elevance plan, while awarding contracts to incumbents UnitedHealth and Centene. The contracts are worth roughly $4 billion annually.
By Rebecca Pifer • May 15, 2024 -
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Hospitals charged employers and insurers 254% more than Medicare in 2022: study
Hospitals with larger market shares were among the worst offenders, the Rand Corporation found.
By Susanna Vogel • May 14, 2024 -
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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 -
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Humana CEO Bruce Broussard to depart July 1
At that time, current Chief Operating Officer Jim Rechtin will take the reins of the health insurer, which is struggling with challenges in Medicare Advantage.
By Rebecca Pifer • May 14, 2024 -
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Deep DiveMedicare Advantage unrest, Change Healthcare fallout and more big takeaways from insurers’ Q1
All major payers saw elevated utilization but only an unprepared few struggled with the trend, the Change Healthcare cyberattack caused minimal financial fallout and a new D-SNP rule opens the door to a Medicare growth opportunity.
By Rebecca Pifer • May 13, 2024 -
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CHS sues MultiPlan for allegedly colluding to lower provider reimbursement
It’s the third lawsuit filed against MultiPlan by a health system in under a year.
By Rebecca Pifer • May 10, 2024 -
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CMS proposes mandatory kidney care model with financial risk for hospitals
The model, if finalized, will test whether putting hospitals on the hook for kidney transplant access and quality might improve the nation’s shoddy system of organ procurement and transplantation.
By Rebecca Pifer • May 9, 2024 -
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MA health assessments contribute to inflated coding intensity: study
Some limits on how the assessments are used might be justified to ensure Medicare Advantage plans aren’t overpaid, researchers wrote.
By Emily Olsen • May 8, 2024 -
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Medicare go-broke date extended to 2036, but warning bells continue ringing
The Medicare trustees’ new projection for insolvency is five years later than previous forecasts, but budget hawks warned action is still needed to shore up the insurance program’s finances.
By Rebecca Pifer • May 7, 2024 -
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Cigna writes down VillageMD investment amid shrinking value
Walgreens’ decision to slash VillageMD’s clinical footprint has reverberated to the financial accounts of the primary care chain’s minority owner — Cigna.
By Rebecca Pifer • May 2, 2024 -
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CVS acquires Medicare Advantage broker Hella Health
The acquisition comes amid rising regulatory scrutiny of insurance brokers and notable turbulence in MA.
By Sydney Halleman , Rebecca Pifer • May 1, 2024 -
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CVS slashes 2024 outlook — again — as Medicare seniors drive spending
Runaway inpatient spending in particular caused CVS’ insurance costs to snowball after returning “to patterns we have not seen since the start of the pandemic,” its CFO said.
By Rebecca Pifer • May 1, 2024 -
Ruben Sprich/Reuters
Change Healthcare cyberattackChange Healthcare, compromised by stolen credentials, did not have MFA turned on
Failing to turn on multifactor authentication, a common cybersecurity safeguard, “underscores pure negligence on the part of UnitedHealth,” one expert said.
By Matt Kapko • April 30, 2024 -
Permission granted by CorroHealth
Sponsored by CorroHealthEmpowering healthcare providers against rising payer denials
The rise in denial rates is more than a mere statistic; it's a symptom of a broader systemic challenge that calls for strategic foresight and robust expertise.
April 29, 2024 -
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Kaiser exposed up to 13.4M plan member records to third parties
The largest data breach reported so far this year comes as regulators reconsider healthcare’s use of tracking technologies.
By Susanna Vogel • April 26, 2024 -
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Centene looks beyond Medicaid redeterminations
The nation's largest Medicaid insurer expects to return to normal operations this year, though redeterminations continue to dog Centene through a mismatch between rates and acuity.
By Rebecca Pifer • April 26, 2024 -
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Molina to challenge Medicaid contract losses in Florida, Virginia
Despite business growth in the first quarter, Molina reiterated its prior 2024 guidance out of caution that it won’t be able to reprocure the contested contracts.
By Rebecca Pifer • April 25, 2024 -
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Deep DiveCalifornia, Oregon eye universal health coverage
The states' proposals, which resemble Medicare for All, need approval from the federal government and face pushback from major health systems and insurers.
By John Canham-Clyne • April 24, 2024 -
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Humana withdraws 2025 earnings outlook on unsatisfactory MA rates
Because of the final rates for next year, Humana will have to enact “larger benefit reductions to achieve stable margins,” its CFO told investors.
By Rebecca Pifer • April 24, 2024 -
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Medicaid final rules hand hospitals win on supplemental payments
In two final rules issued Monday, the CMS also moved to crack down on financing gimmicks used by states and hospitals to increase federal Medicaid funding — though not until 2028.
By Rebecca Pifer • April 23, 2024 -
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 18, 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 -
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 -
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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 redeterminations
More 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
