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Humana’s latest purchase morphs into a sale

We’re feeling a bit buffeted by multiple aftershocks here. Humana’s chess pieces just keep sliding around the board. First, the insurer snapped up full ownership of Kindred at Home, the biggest home… Read More

Payor? Provider? Insurance industry lobbyist gets less clear

When Kentucky Fried Chicken changed its name to KFC there was little doubt in anyone’s mind that they were still serving up classic deep-fried poultry. But according to the company, the rebranding… Read More

Is a year’s worth of pent-up medical care about to hit?

As the COVID-19 pandemic upended our lives over the past year, many people delayed aspects of their medical care and postponed elective procedures. But now that the country is starting to open… Read More

While its front end dips, the rest of CVS’ business soars

CVS Health’s vertical healthcare model is proving lucrative—and to us, is starting to look dauntingly powerful. As you may know, the company owns an international string of pharmacies, a pharmacy-benefit manager and—the… Read More

A new diagnosis: Munchausen syndrome by payor?

We’ve heard of Munchausen syndrome by proxy, but Anthem’s latest billing snafu has us wondering if a new diagnosis is in order — Munchausen syndrome by payor. A report by the Office… Read More

Where telehealth goes from here

We’ve shared before how we’re anxiously waiting to see how telehealth will be treated in upcoming contract hospital-insurer negotiations. Now, Congress is debating how to expand access to telehealth as the pandemic’s… Read More

Cigna is sitting pretty, not sitting still

It looks like Cigna Corp. has found the health insurance industry’s sweetest of sweet spots. Two of the most lucrative places to be right now, if you’re Big Insurance, are the pharmacy… Read More

Are the Michigan Blues really ready to settle?

We’ve got an update on the antitrust suit against Blue Cross Blue Shield of Michigan—and it’s got a fun twist at the end. We’ve already covered part one of this story, about how… Read More

Oops, Humana did it again

Is it just us, or do health insurers seem to be, um, taking advantage of Medicare Advantage (MA)? This year alone, we’ve seen stories about Cigna and Anthem hitting stop signs on their… Read More

It was a very good year (if you’re a health insurance exec)

In reviewing Health Care Service Corp. (HCSC)’s executive compensation for 2020, Modern Healthcare threw out some pretty big numbers. Its CEOs (there were two, during different parts of 2020) reaped a combined… Read More

United is on the gain: Profits, members, and scrutiny

Spring is in the air, which means that it’s time for Q1 reports. As Insider Intelligence’s eMarketer article details, UnitedHealthcare shows soaring numbers, both in membership, which grew by more than 1… Read More

Artificial intelligence in healthcare: Does it lower costs for patients or lower the costs of patients?

Healthcare Dive recently broke the news that med-tech startup K Health is partnering with two major players—health insurer Anthem and investment management giant Blackstone Growth—to launch a joint venture called Hydrogen Health.… Read More

Who’s running the Medicare Advantage show?

Becker’s Hospital Review recently ran down the top for-profit insurers with the largest national share of Medicare Advantage members, based on a report by the Chartis Group, a healthcare management consulting firm.… Read More

Megabucks for managed care

A massive arrangement has been reached between Ohio and six insurance companies hired to coordinate Medicaid managed insurance for more than 3 million low-income and/or disabled state citizens. It’s set to go… Read More

The 2021 financial prognosis for hospitals: Critical condition

If you look at the ledgers of the country’s largest health insurance companies, you could be forgiven for assuming that the COVID-19 pandemic has actually been a boon to the healthcare industry… Read More

Mississippi to Centene: I want my millions back too!

When the Mississippi Department of Medicaid contracted with Centene Corp. subsidiary Magnolia Health to manage care for the nearly half a million lower-income adults and children in its Medicaid system (MississippiCAN), state… Read More

“Information wants to be free”

So, here’s a clever way to bolster an insurance company’s annual profit report: Charge physicians to access claims payment data. Sound crazy? Well, that’s what UnitedHealthcare was doing, until recently, through its… Read More

It’s 2021: Do you know where your personal data is?

Earlier this year, UnitedHealth Group’s Optum subsidiary bought itself a present: the data analytics firm Change Healthcare, which is a massive administrative network that processes claims and pharmacy requests for physicians and… Read More

Non-newsflash! Billions are wasted dealing with health insurance hassles

We’ve often wondered where the biggest healthcare sinkhole is when it comes to lost revenue due to administrative hassles. Until now, our guess was the drain on physicians’ and hospitals’ time spent… Read More

Who loses in a rigged game of high-deductible health plans? American workers, every time

We’ve all played three-card monte, right? Three cards face down; pick the queen and win the green. Why is this game so successful? Because the marks (the suckers who step up to… Read More

A denial for health insurers’ COVID-19 testing denials

We’ve recently shared a string of examples, from insurers dodging reimbursement for kids’ COVID-19 tests to insurance giant Cigna being sued into covering tests. Now the issue has reached the point where the… Read More

Where do health insurance companies’ billions in profits go? A lot of it rises to the top

The article was based on consulting firm BDO’s recently released Health Insurance Executive Insights Report, which covers compensation for executives and senior managers at health insurance companies, including UnitedHealth Group. According to… Read More

Beware of cherry-picked data from RAND

The RAND Corporation released an Impact of Policy Options for Reducing Hospital Prices Paid by Private Health Plans “study” that claims to have found upwards of $62 billion in potential healthcare savings—if… Read More

In every way, Optum is getting bigger. And bigger, and bigger

We’ve said it before: One man’s pandemic is another man’s windfall. Especially when that “man” is UnitedHealth Group, which appears to be taking the profits it’s piled up during the COVID-19 pandemic… Read More

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