AmeriLife’s suit joins at least two others from MA sales groups seeking revisions to the rule for threatening their business model. It also comes with a clock, given a looming deadline for marketing contract negotiations.| Healthcare Dive
Humana is giving investors an early look at stars data after a CMS slip-up led some information to be inadvertantly shared online. The results are in line with expectations but still unsatisfactory, Humana said.| Healthcare Dive - Latest News
Implementing artificial intelligence requires significant human labor and technical expertise, threatening to create a digital divide between highly resourced health systems and safety-net providers.| Healthcare Dive - Latest News
The coverage landscape for the privatized Medicare plans will look significantly different next year, giving smaller players a chance to snap up market share but likely creating confusion for seniors.| Healthcare Dive - Latest News
"We’ve worked hard, but have not made as much progress as is needed," CFO Daniel Morissette said about the company’s 2025 financial results.| Healthcare Dive - Latest News
The agency is looking for ways to detect, assess and mitigate changes to the performance of AI-enabled devices over time.| Healthcare Dive - Latest News
Extending the more generous financial assistance is at the center of a funding fight between Democrats and Republicans on Capitol Hill that shut down the federal government early Wednesday.| Healthcare Dive - Latest News
Congress failed to extend the pandemic-era telehealth policies before they lapsed on Oct. 1. Now, providers are scrambling to manage the disruption to virtual care reimbursement and access.| Healthcare Dive - Latest News
The $515 million deal has closed after roughly two years, creating the first hospital system owned by a venture capital company.| Healthcare Dive - Latest News
These are the events healthcare leaders should plan for next year, covering topics like digital health, rural care and financial management.| Healthcare Dive - Latest News
A pact to offer “most favored nation” prices to state Medicaid programs and via direct-to-consumer channels doesn’t affect those on commercial insurance or who won’t pay out of pocket.| Healthcare Dive
Medical leaders including the HHS argue the ruling against race-conscious admissions policies could roll back gains in the number of minority physicians and ultimately hurt health outcomes.| Healthcare Dive
The EMR giant settled a dispute over allegations from a North Dakota hospital that its financial software was defective.| Healthcare Dive
Sens. Ron Wyden and Elizabeth Warren are seeking more information from the beleaguered healthcare behemoth after The Guardian found it was incentivizing nursing homes to reduce hospital transfers.| Healthcare Dive
Creagh Milford is taking the reins at the value-based medical group for seniors after Oak Street’s previous president decided to step down.| Healthcare Dive
The company raised its outlook as many insurers are struggling with elevated medical costs in the second quarter.| Healthcare Dive
With the deal’s completion, CVS adds a multi-state chain of medical clinics for seniors to its primary care roster.| Healthcare Dive
The combined company will work on care delivery and engagement, particularly for Medicare Advantage customers, according to an announcement.| Healthcare Dive
Jon Thiboutot, most recently the vice president of operations of CVS' MinuteClinic subsidiary, has been named the healthcare giant's president of retail health.| Healthcare Dive
The findings build on other research suggesting that MA insurers restrict care more than they should, especially post-acute services.| Healthcare Dive
In a new report from Medscape, physicians say a lack of qualified applicants is hampering efforts to fill open positions. Many worry the situation could get worse over the next decade.| Healthcare Dive
More than half of respondents saw more procedure complications or reported poor outcomes due to care delays, while 28% said mortality rates rose.| Healthcare Dive
CMS will provide states monthly reports of beneficiaries whose citizenship or immigration status cannot be confirmed. States are expected to take “appropriate actions” including limiting coverage, the agency said.| Healthcare Dive
Lawmakers on both sides of the aisle are taking a harder look at coverage denials, fraud and waste in the popular program.| Healthcare Dive
The lawsuit alleges UnitedHealth used nH Predict to deny claims despite the algorithm’s determinations being overturned in more than 90% of appeals.| Healthcare Dive
Nearly three in four providers surveyed by Experian Health said the number of claims denied by payers shot up between 2022 and 2024.| Healthcare Dive
More than 80% of denied requests were overturned when appealed, but few beneficiaries formally questioned the decisions.| Healthcare Dive
The insurer is the latest to be hit with a suit over its use of algorithms to appraise claims.| Healthcare Dive
Physicians surveyed by the American Medical Association say prior authorization can cause care delays or force patients to abandon treatment. Denials could also increase as insurers adopt AI to review claims.| Healthcare Dive
Major insurers have agreed to six commitments that should make accessing care easier for patients while removing administrative burden on providers. But, the pledges’ voluntary nature makes compliance an open question.| Healthcare Dive
Beginning next year, the CMS will launch an AI-powered prior authorization process for some services as it seeks to cut funding for what it deems medically unnecessary care.| Healthcare Dive
The CMS plans to trial prior authorization requirements in traditional Medicare. A group of Democrat representatives think that’s a bad idea based on the tool’s track record in Medicare Advantage.| Healthcare Dive
Less than two weeks after stepping down, Prasad will return to lead CBER “at the FDA’s request,” an HHS spokesperson said. It's the latest twist in an unusual run to lead the FDA office overseeing vaccines and gene therapy.| Healthcare Dive
The healthcare juggernaut’s results came in unusually below Wall Street’s expectations and caused its stock to plummet Thursday. The development bodes ill for the rest of the managed care sector, analysts said.| Healthcare Dive
Osterhaus Pharmacy in Iowa — which is also suing CVS Caremark — is taking issue with pharmacy benefit managers’ use of performance-based fees that it says are contributing to independent pharmacy closures.| Healthcare Dive
The bipartisan agreement will fund the government through March. It could also reshape the pharmacy supply chain by reforming how controversial drug middlemen do business.| Healthcare Dive
The PBM Act would make companies like CVS and UnitedHealth that own health insurers or PBMs sell pharmacy assets. That would help independent pharmacies, but may not help patients, according to one expert.| Healthcare Dive
Agency commissioners voted unanimously on Tuesday to publish the report, which makes similar allegations against the controversial drug middlemen as the agency’s first report released last summer — but relies on more data.| Healthcare Dive
The KFF’s projection is steeper than an older analysis that relied on less complete data. It’s the largest increase that ACA insurers have asked for in more than five years as payers brace for membership turmoil.| Healthcare Dive
The American Civil Liberties Union called the ruling “a major victory for public health.” Federal officials are exploring their legal options, including an appeal.| Healthcare Dive
The Government Accountability Office can file a lawsuit in an attempt to restore the grants. However, the agency has not opted to do so during the second Trump administration.| Healthcare Dive
The healthcare giant’s new estimate is roughly $1 billion higher than previous forecasts as the cyberattack on subsidiary Change Healthcare continues to hamper its profit outlook.| Healthcare Dive
Centene continued to deal with a mismatch between Medicaid rates and patient acuity in the second quarter, but still exceeded Wall Street’s expectations thanks to Affordable Care Act growth.| Healthcare Dive
Conservative planning and continued business growth helped Molina keep an ongoing mismatch between payment rates and member acuity from dinging its bottom line in the third quarter.| Healthcare Dive
The insurer shrank its plan footprint for 2025 in a bid to improve margins. Now, Humana is giving market watchers loose guidance into how that reduction could affect its enrollment along with second quarter results.| Healthcare Dive
CenterWell said it will lease space at Walmart Supercenter stores in four states.| Healthcare Dive
Financial challenges at rural hospitals — driven by reimbursement problems — are leading facilities to shutter labor and delivery wards, the report found.| Healthcare Dive
One challenge hospitals face is reimbursement from private payers, which doesn’t cover the higher costs of care in rural areas, according to a report by the Center for Healthcare Quality and Payment Reform.| Healthcare Dive
Dually classifying allows urban facilities to benefit from rural health programs, even as many rural facilities struggle financially and are at high risk of closure, researchers wrote.| Healthcare Dive
Top executives of CVS Caremark, Optum Rx and Express Scripts made a rare congressional appearance to defend pharmacy benefit managers’ drug pricing policies.| Healthcare Dive
Pharmacy benefit manager lobby PCMA and drugmaker lobby PhRMA pointed fingers over problems in the prescription supply chain during the House committee's second PBM hearing on Tuesday.| Healthcare Dive
Antitrust regulators are poised to file suit against CVS Caremark, Express Scripts and Optum Rx over how they negotiate discounts for drugs, including insulin, according to the report.| Healthcare Dive
The report is not positive for the drug middlemen, which immediately criticized it as one-sided.| Healthcare Dive
Pharmacy groups cheered the news, which reversed a vote earlier this year by FTC commissioners not to investigate PBMs' pricing and contractual practices.| Healthcare Dive
The major PBM said its lawsuit is necessary to protect against misinformation about the controversial drug middlemen, while the FTC promised to defend its research.| Healthcare Dive
The Cigna-owned pharmacy benefit manager colluded with rival Prime Therapeutics to overcharge pharmacies, according to a lawsuit filed last week.| Healthcare Dive
Pharmacy benefit managers have largely avoided the brunt of public blame for the deadly opioid crisis. Arkansas’ lawsuit brings the drug middlemen back to the forefront of the controversy.| Healthcare Dive
Major pharmacy benefit managers continue to double down on specialty as a reliable source of business amid a growing crop of pharmacy upstarts.| Healthcare Dive
The infusion services and drug therapy company will operate under CarelonRx, Elevance’s pharmacy benefit manager.| Healthcare Dive
Worries about higher-than-expected medical spending have reached Medicaid, as redeterminations spark turbulence in the program.| Healthcare Dive
The investment, which the foundation says is its largest in women’s health, will support research in maternal health, obstetric care and sexually transmitted infections, among other areas.| Healthcare Dive
A coalition of 16 states and Washington, D.C. argue the Trump administration is trying to ban youth gender-affirming care without going through Congress.| Healthcare Dive
The watchdog said the payer submitted documentation that inaccurately showed some of its Medicare Advantage members were sicker than they actually were.| Healthcare Dive
The payer said it plans to vigorously defend its practices as the lawsuit alleges it put profits ahead of compliance.| Healthcare Dive
The payer used a medical assessment program to find health conditions that could raise risk scores of plan members, offering incentives to physicians who gave the exam, according to the lawsuit.| Healthcare Dive
Lagging vaccination rates lead the company to expect the pandemic to be a "modest negative for 2021," CFO Shawn Guertin said. Previously, it expected COVID-19 to have little to no impact on full-year earnings.| Healthcare Dive
The insurer is the latest to face allegations of receiving Medicare Advantage overpayments tied to patients who were inaccurately identified as part of a high-risk group.| Healthcare Dive
More than 60 companies, including Amazon, Google, UnitedHealth and Epic, have pledged to participate in the initiative, which the CMS said would “deliver results” early next year.| Healthcare Dive
Few concrete details emerged from the branding bid, but Haven's website and a letter from CEO Atul Gawande set lofty guiding principles for the venture.| Healthcare Dive
Legislation passed earlier this year also expanded premium tax credits and helped drive down premiums. More than 90% of those who enrolled during the SEP saw their premiums reduced.| Healthcare Dive
For most payers, higher-than-expected coronavirus costs were offset by patients continuing to delay nonessential medical care.| Healthcare Dive
An ongoing SEC probe could pose a significant risk to the payer, which gets most of its revenue from government programs.| Healthcare Dive
At question is whether insurers will be able to shift Medicaid members who lose coverage to subsidized marketplace plans.| Healthcare Dive
Children are at highest risk in Texas, Florida and Georgia when states resume checking Medicaid eligibility after the public health emergency expires, Georgetown University researchers found.| Healthcare Dive
The three-year continuation of enhanced subsidies for Affordable Care Act plans should help millions afford coverage and create some revenue stability for payers and hospitals in a tricky operational environment.| Healthcare Dive
Policy experts are worried, however, that progress on coverage expansion will be threatened when a moratorium on Medicaid disenrollment ends.| Healthcare Dive
At the latest congressional inquiry into pharmacy benefit managers, lawmakers argued the middlemen profit at the expense of patients and taxpayers.| Healthcare Dive
“The road ahead for prescription drug and pharmacy looks quite daunting,” said the CEO of the Business Group on Health following a recent survey.| Healthcare Dive
BSCA has kicked CVS Caremark, the largest pharmacy benefit manager in the country, to the curb and is electing to carve out various pharmacy functions with companies like Amazon instead.| Healthcare Dive
Cigna’s health services division Evernorth is also taking a stake in the deal, and will become a minority owner in VillageMD.| Healthcare Dive
Executives said Thursday that COVID-19-related costs were also higher than anticipated for the quarter.| Healthcare Dive
One analyst asked whether not pursuing deals will pose a disadvantage in future years. CEO David Cordani said he is open to M&A but does not think acquisitions are a “silver bullet.”| Healthcare Dive
It would have been the first time a sitting U.S. president attended the annual HIMSS conference, now canceled over coronavirus concerns.| Healthcare Dive
Promoting interoperability without clear guardrails could lead to healthcare's version of Cambridge Analytica, Epic wrote in a public statement coinciding with ONC's annual health IT conference.| Healthcare Dive
Officials from LifePoint, Omada Health and an IT group told a Senate panel more time is needed to process the rules and for implementation.| Healthcare Dive
The new iteration brings normative status, meaning future changes will be backward compatible.| Healthcare Dive
"Cancellation is unavoidable in order to meet HIMSS' obligation to protect the health and safety of the global HIMSS community," conference organizers told vendors Thursday.| Healthcare Dive
The AHA is pushing back against a proposal that electronic event notification be required to take part in Medicare and Medicaid.| Healthcare Dive
Star ratings bonuses reached $12.8 billion, according to the KFF, as the Medicare program faces a growing spending crisis.| Healthcare Dive
The QBP is a significant source of revenue for MA insurers, but generally doesn’t translate to higher quality care for beneficiaries, according to the nonprofit’s new report.| Healthcare Dive
Just 21% of CVS’ MA members are currently in plans with a star rating of at least four, down from 87% at the end of 2021, the payer disclosed.| Healthcare Dive
The budget also proposes to extend Medicare solvency and give the federal government more power to negotiate prescription drug prices.| Healthcare Dive
More than 100 current and former CommonSpirit facilities in 13 states might have been affected by the ransomware attack on the health system last year.| Healthcare Dive
The ratings agency said healthcare’s vulnerable state makes it “target rich,” which could bring service disruptions and personal data disclosures.| Healthcare Dive
The health system failed to implement safeguards to secure patients’ health information and provided insufficient details about the stolen data, the suit alleges.| Healthcare Dive
Celeste Mellet, currently the finance chief at an infrastructure investment fund, will take on the insurer’s CFO role in early January.| Healthcare Dive
Friday’s district court ruling is the latest suggesting the CMS might have to recalculate every MA plan’s star rating score due to an administrative oversight.| Healthcare Dive
The payer joins several other insurers suing federal regulators over the 2025 quality ratings, which Elevance argues will cost it at least $375 million in bonus payments and rebates.| Healthcare Dive
Centene is emulating other insurers unhappy with how regulators handled quality ratings for 2025. The flurry of complaints is “symptomatic of what appear to be systemic issues” with CMS calculations, Centene said.| Healthcare Dive
A handful of plans owned by the nation's largest MA payer are the latest to ask the court to help raise their valuable quality scores.| Healthcare Dive
