Payer
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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 -
CVS acquires Medicare Advantage broker Hella Health
The acquisition comes as the Biden administration increasingly scrutinizes MA brokers.
By Sydney Halleman , Rebecca Pifer • May 1, 2024 -
Trendline
Social 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 -
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 -
Change Healthcare cyberattack
Change 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 -
Sponsored by CorroHealth
Empowering 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 -
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 -
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 -
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 -
Deep Dive
California, 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 -
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 -
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 -
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 -
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 -
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 -
Change Healthcare cyberattack
UnitedHealth 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 -
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 -
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 -
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 -
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 -
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 -
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 -
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 -
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 -
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 -
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