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Humana invades the home health business

In April, we covered Humana branding its health services arm to bring together its primary care, pharmacy, and in-home care services under the name CenterWell. While we pontificated on Humana’s dramatic growth, it… Read More

United announces plans to deny ED claims retroactively

Let’s say you have a pain somewhere in your gut in the middle of the night. You’re not sure where it came from; it gets worse and then better, but it’s not… 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

Patients in limbo as Cigna splits with a health system

On May 30, health insurer Cigna ended its contract with Virginia-based Mary Washington Healthcare. The reason it states is a failure of the two parties to come to terms on charges and… 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

Forget telehealth. We’ve got an app for that.

Cigna’s latest offering for its 14 million members is a behavioral health coaching, therapy, and psychiatry services app called Ginger. This new product is reflective of a steadily increasing demand for behavioral… Read More

Is Anthem heading for an Epic fail?

Anthem (big health insurance company) is going to team up with Epic (large data analytics and health tech company) to leverage Epic’s massive medical records database for its internal purposes. Through this… 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

Can the new kid on the block make it?

Who is Centene, you may ask? This brazen health insurer shot up seemingly out of nowhere (well, Wisconsin) to become a significant player in the market, with annual revenues (and vertical integration… Read More

A closer look at Optum, United’s fastest growing business

We talk a lot about Optum in terms of its place in the UnitedHealth Group family tree, and how it fuels its parent company United’s growth. But a recent piece in Fierce… Read More

The feds take a closer look at mental healthcare coverage

To set the stage, let’s look at how things were before the pandemic. A recent report by the Government Accountability Office (GAO) paints a picture of a behavioral health system that was… Read More

A surprise bill from United (that we could have seen coming)

Insurers like to lay the blame for surprise medical bills on providers. Sometimes, they’re even brazen enough to blame their own members, claiming that they have failed to scrutinize their insurance coverage… 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

What happens when insurers take the doctor out of the equation?

In a recent article, Modern Healthcare shared some of the repercussions of a growing trend: health insurance companies taking patients’ pharmaceutical care from doctors. It’s clear that insurers can reap massive financial… Read More

There’s big money in those PBMs

The stats on the expansion of IngenioRx, Anthem’s pharmacy benefit manager (PBM), are hot off the presses—and the numbers are big. To help put them in context, here’s a quick primer on… 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

Evernorth’s high-rise portfolio gains another story

On April 20, Healthcare Dive updated a story we’ve been following about the acquisition of telehealth company MDLive by Evernorth, the recently re-branded primary health services umbrella group of Cigna. The Dive story… 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

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