STAT+: ‘Style over substance?’ Express Scripts launches new pricing plan amid rising scrutiny of PBMs
Amid increasing scrutiny of pharmacy benefit managers, Express Scripts is launching a new pricing plan…
Category: insurance
STAT+: Federal group studying surprise ambulance bills will finally meet — five months late
The federal committee in charge of finding ways to stop surprise billing from ground ambulances…
STAT+: UnitedHealth’s physician buying spree continues with takeover of Crystal Run
UnitedHealth Group has acquired Crystal Run Healthcare, a prominent physician group in New York. The…
STAT+: Wall Street embraces health insurers after scoring Medicare Advantage payment win
Health insurance companies that participate in Medicare Advantage will retain billions of extra taxpayer dollars…
STAT+: Medicare Advantage plans will have to stop denying required care, federal officials say
The Biden administration is moving forward with proposals that would crack down on Medicare Advantage…
STAT+: Biden administration goes easy on Medicare Advantage insurers after intense industry lobbying
WASHINGTON — The Biden administration backed off some of its plans to rein in billions…
STAT+: Drug middlemen switch tactics, but the outcome is the same: high prices
WASHINGTON — Prescription drug middlemen are shifting away from rebates that have been blamed in…
Texas judge strikes down major Obamacare provision protecting birth control, PrEP coverage
WASHINGTON — A federal judge Thursday reversed a major Obamacare provision requiring plans to cover…
STAT+: Oscar Health names former Aetna executive as new CEO
The tech-forward insurer Oscar Health has tapped former Aetna CEO Mark Bertolini to be its…
STAT+: Wary of changes to Medicare Advantage, health insurers put up a fight — and exaggerate the stakes
For the past two months, the health insurance industry has attempted to scare older adults…
STAT+: Key senators blast Medicare Advantage insurers for ‘exorbitant salaries,’ ‘massive payouts’ to execs
WASHINGTON — Sens. Elizabeth Warren (D-Mass.) and Jeff Merkley (D-Ore.) slammed seven different Medicare Advantage…
STAT+: Drugmakers push back on a clever tactic employers use to avoid paying for specialty medicines
In the face of rising drug prices, health plan sponsors have quietly used a clever,…
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STAT+: Federal Medicaid officials cajole states to auto-enroll beneficiaries as huge coverage losses loom
WASHINGTON — Federal Medicaid officials are working unusually closely with states to avoid enrollment glitches…
STAT+: Califf criticizes insurers for doing too little on drug research
WASHINGTON — FDA Commissioner Robert Califf wants private insurers to chip in on doing post-approval…
STAT+: The big-money Medicare policy that has hospitals worried this Congress
WASHINGTON — There are few things that get lawmakers in Washington salivating more than a wonky…
STAT+: Medicare explains how it will choose drugs for negotiation
WASHINGTON — Medicare laid out Thursday in the greatest detail yet how it will choose…
STAT+: Would the federal government defer to states to regulate PBMs?
WASHINGTON — After years of struggling to regulate the drug middlemen that create pharmacy networks,…
STAT+: PhRMA chief dings health insurers over drug prices at their own conference
WASHINGTON — The head of the brand drug lobby used an in-person health insurance industry…
STAT+: Buyer’s remorse: How a Medicare Advantage business is strangling one of its first funders
When NaviHealth began building a business around using algorithms to scrutinize the care of older…
Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need
An algorithm, not a doctor, predicted a rapid recovery for Frances Walter, an 85-year-old Wisconsin…
STAT+: Many doctors spend their days battling insurers. Why do some go to work for ‘the dark side’?
Gastroenterologist Alin Botoman had been on hold for almost an hour. The drone of muzak…
STAT+: Biden administration floats major 2024 pay cut for Medicare Advantage plans
Medicare Advantage insurers could face an average 2.3% cut to baseline payments in 2024, the…
STAT+: Medicare Advantage insurers will score $2 billion gift thanks to limited audits
Medicare officials made a clear statement four years ago about how best to audit the…
STAT+: Medicare Advantage insurers to repay billions under final federal audit rule
The federal government will audit Medicare Advantage insurers aggressively under a rule finalized Monday, which…
STAT+: ‘Everybody has blood on their hands’: A decade-long battle over Medicare Advantage audits is coming to a head
The federal government and health insurance companies have been clashing for more than a decade…
Opinion: Reinventing health care in 2023
After a year defined by record inflation and double-digit health care premium increases, I hope…
Opinion: Upcoding: one reason Medicare Advantage companies pay clinicians to make home health checkups
At the start of 2023, an estimated 2.5 million Americans age 65 and older began…
STAT+: Hip and knee replacements go better when performed by high-volume surgeons, new study finds
A new study underscores the importance of the adage “practice makes perfect,” especially when it…
STAT+: Hospitals gear up to expand market power, raise prices in 2023
SAN FRANCISCO — More than a dozen of the country’s large not-for-profit hospital systems descended…
Opinion: For addiction treatment, longer is better. But insurance companies usually cut it short
Access to treatment for addiction has long plagued U.S. health systems. Why? Two reasons: It…
STAT+: Oscar Health’s CEO on post-hype health insurance and finally turning a profit
Oscar Health has excelled at one thing in particular since its inception a decade ago:…
STAT+: Drastic changes should bring profitability, startup health insurers say
Startup insurers Oscar Health, Bright Health, and Clover Health have hemorrhaged money since going public…
STAT+: Insurers hint at suing Biden administration over plans for Medicare Advantage audits
Big health insurers who spoke at the J.P. Morgan Healthcare Conference are gearing up to…
STAT+: Hospitals say peak labor costs are behind them
SAN FRANCISCO — Rising labor costs has been the main financial concern for hospitals over…
STAT+: Medicare Advantage-focused Oak Street, Agilon Health chart out growth at J.P Morgan
Senior-focused primary care providers Oak Street Health and Agilon Health used their stage time at…
STAT+: Study finds heavier reliance on nurse practitioners, physician assistants after private equity takeovers
A new study suggests physician practices acquired by private equity rely more heavily on advanced…
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STAT+: The health care providers and insurers we’re watching at JPM23 — and why
Hospitals, health insurers, and other provider-related companies are returning in person to the J.P. Morgan…
STAT+: 3 trends to watch in hospitals and health insurance in 2023
For almost three years, hospitals and health insurers have been riding the waves of the…
STAT+: Providers seeking resolution of billing disputes under the No Surprises Act cause a major backlog of cases
Health care providers are swamping the government with billing disputes under the new law that…
Opinion: How value-based payments to clinicians can help close equity gaps
The U.S. health system has been evolving over the past decade to focus on the…
After nine months, an update on NIH’s long Covid research
You’re reading the web edition of D.C. Diagnosis, STAT’s twice-weekly newsletter about the politics and…
STAT+: Biden administration takes aim at Medicare Advantage care denials, misleading ads
The Biden administration has unveiled its plan for attacking people’s chief concerns about privatized Medicare…
Opinion: Paid sick leave is good for workers — and U.S. public health
The fight to expand access to paid sick leave continues even after President Biden decided…
STAT+: The Covid-19 test maker that pivoted to being a health insurance company
Curative rose to prominence during the throes of the pandemic, as people and governments across…
Psychedelic therapy is moving to the next frontier: workplace perk
Acupuncture and chiropractic care weren’t always the common fixtures of employer benefit plans they are…
STAT+: The health insurer will see you now: How UnitedHealth is keeping more profits, as your doctor
Next year, UnitedHealth Group — one of the largest health care companies on the planet…
Medical malpractice lawsuits, delayed by the pandemic, are hitting hospitals harder than expected
Carlos David Castro Rojas was a healthy 27-year-old engineering student when he fell off a…
STAT+: Patient groups push federal government to enforce health care price estimates
People don’t receive bills after going to a grocery store or a mechanic’s shop. They…
STAT+: With VillageMD investment, Cigna bets on value-based care for a younger, healthier crowd
These days, if you’re an insurer and you’re not buying into the health care provider…
STAT+: Unexpected troubles hit large medical billing firm R1 RCM, part-owned by Ascension
The stock price of R1 RCM tanked by roughly 50% this week after the large…