Plus, the 'stunning' court ruling on 340B

This Week

Nov 11, 2023

Cigna explores selling Medicare Advantage business: report


Amazon's latest perk for Prime members includes discounted One Medical virtual care


'Stunning' court ruling broadens hospitals' 340B use, calls HRSA's enforcement authority into question


CMS targets predatory MA marketing practices, proposes prior auth and behavioral health changes


Kaiser Permanente logs $239M net income, 0.6% operating margin in Q3 2023 - Paige Minemyer

 

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Cigna explores selling Medicare Advantage business: report

Cigna may decide to sell off its Medicare Advantage business. The insurer is reportedly in early discussions with an investment bank to go over its options.
 

Top Stories

Amazon's latest perk for Prime members includes discounted One Medical virtual care

Building on its One Medical deal, Amazon is now offering a One Medical for Prime membership, including 24/7 virtual care, for $9 per month, or $99 a year.

'Stunning' court ruling broadens hospitals' 340B use, calls HRSA's enforcement authority into question

Alongside a broader definition of a "patient" under the drug discount program, legal experts say that Friday's federal district court decision will have downstream effects for ongoing disputes over drugmaker's contract pharmacy restrictions and hospitals' child site registration requirements.

CMS targets predatory MA marketing practices, proposes prior auth and behavioral health changes

In another proposed rule, CMS aims to tighten Medicare Advantage prior authorizations, establish a maximum payment structure for marketing middlemen and loosen requirements on biosimilar formularies.

Kaiser Permanente logs $239M net income, 0.6% operating margin in Q3 2023

The massive integrated nonprofit's $156 million operating income turns around the $75 million operating loss of the third quarter of 2022 but is a slight pullback from 2023's prior quarters.

Industry Voices—UnitedHealthcare's Advance Notification program is getting in the way of patient care

The time-sensitive GI procedures that UHC is targeting with prior authorization are critical in helping to detect, treat, and monitor a range of diseases that impact millions of Americans.

Amid concerns about claims denials, Democrats seek greater oversight of Medicare Advantage plans' use of AI

Medicare Advantage prior authorization denials are in the crosshairs of House Democrats. They say evidence points toward insurers willingly allowing algorithms to wrongfully deny service to patients.

Senate votes to reform PBMs again, stop $16B in hospital cuts

A comprehensive healthcare package garnered near unanimous approval on Wednesday, which could lead to big changes for PBMs down the road.

Increases in value-based payment adoption decreased family physician burnout, AAFP study finds

The study found that higher capitation rates combined with greater overall percentage of revenue from capitation resulted in the biggest reduction in physician burnout.

Medical billing startup Cedar rolls out new features to connect patients with financial assistance options

The company launched a new software suite, called Affordability Navigator, to connect consumers with outside funding sources and self-service tools. It also integrates Medicaid enrollment into the billing experience.
 
Fierce podcasts

Don’t miss an episode

'Podnosis': Leading with empathy amid crisis

Hello Heart is a U.S.-based company with offices in California and New York, and it also has a significant presence in Israel, with the majority of its roughly 80 employees there working from the Tel Aviv office. In this week’s episode of “Podnosis,” Hello Heart CEO Maayan Cohen, who resides in Tel Aviv, shares her personal experience during a challenging moment when she was on her way to the annual HLTH conference in Las Vegas and heard about the October 7th attack by Hamas on Israel.
 

Resources

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Research: How Automation Eases Periop Care Coordination

Research suggests how automation can ease perioperative care coordination challenges.
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Reimbursement Blueprint: 4-Step Guide to a Successful Pharma HUB

Pharmaceutical HUBs are Underutilized; Yours Doesn’t Have to Be.
 

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