Deep Dive
Industry insights from our journalists
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Medicaid overtakes Medicare Advantage as health insurers’ bogeyman in Q2
Despite challenges in Medicaid and MA, major insurers still posted large earnings in the second quarter — many helped by health services divisions.
Rebecca Pifer • Aug. 15, 2024 -
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FDA’s lab developed test rule could be first check on agency’s power post-Chevron
The Supreme Court’s decision to overturn the Chevron doctrine would make it easier to challenge agency regulations, such as the LDT final rule.
Susan Kelly and Elise Reuter • July 11, 2024 -
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Humana and CVS are downsizing their Medicare Advantage plans for 2025. Which insurers could benefit?
Hundreds of thousands of seniors could switch plans during next year’s open enrollment, depending on how drastically the MA market giants slash benefits in an attempt to improve profits.
Rebecca Pifer • Updated June 10, 2024 -
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Medicare Advantage unrest, Change Healthcare fallout and more big takeaways from insurers’ Q1
All major payers saw elevated utilization but only an unprepared few struggled with the trend, the Change Healthcare cyberattack caused minimal financial fallout and a new D-SNP rule opens the door to a Medicare growth opportunity.
Rebecca Pifer • May 13, 2024 -
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Antitrust agencies are relying on consumers to report anticompetitive behavior. That trust might be misplaced.
Regulators want consumers to flag business practices harming market health in the healthcare sector, which could result in a tsunami of new tips — for good and ill, according to experts.
Rebecca Pifer • May 6, 2024 -
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California, Oregon eye universal health coverage
The states' proposals, which resemble Medicare for All, need approval from the federal government and face pushback from major health systems and insurers.
John Canham-Clyne • April 24, 2024 -
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Steward bankruptcy likely as massive debt remains, with few options left
Steward Health Care’s forbearance period ends in less than 15 days. Analysts say this time, creditors are unlikely to extend the embattled company another lifeline.
Susanna Vogel • April 16, 2024 -
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Change cyberattack serves as wake-up call for healthcare cybersecurity
The outage shows why health systems need to plan for inevitable cyberattacks, evaluating risks and putting operational backups in place, experts say.
Emily Olsen • April 4, 2024 -
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‘As fast as possible but no faster than is safe’: Hospitals, tech companies confront AI governance
Regulators seeking to erect guardrails around AI are facing a Sisyphean task, experts said at HIMSS. How do you oversee something that is constantly changing?
Rebecca Pifer • March 18, 2024 -
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Why Cigna is capping cost increases for pricey GLP-1 weight loss drugs
The move — the first of its kind — comes as pharmacy benefit managers continue to try to prove their value to clients, and shows how major players are shoring up to meet sky-high GLP-1 demand.
Rebecca Pifer • March 8, 2024 -
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Insurers brace for continued Medicare Advantage medical costs
The big question coming out of the health insurance earnings season is how much elevated utilization among seniors is carrying over into 2024.
Rebecca Pifer • Feb. 20, 2024 -
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Trends shaping the business of health insurance in 2024
The uninsured rate will rise. Medicare Advantage enrollment will swell, with less instability. Major pharmacy benefit managers will launch more transparent products. Here’s what industry watchers are expecting in 2024.
Rebecca Pifer • Jan. 16, 2024 -
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Key hospital and provider trends in 2024
As slim operating margins continue to challenge hospitals, experts predict providers will trim unnecessary expenses and focus on strategic labor investments.
Susanna Vogel • Jan. 10, 2024 -
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Healthcare technology trends to watch in 2024
Experts discuss their predictions for healthcare industry trends, including investment and consolidation in digital health, adoption of artificial intelligence and improving cybersecurity in healthcare in 2024.
Emily Olsen • Jan. 8, 2024 -
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A Cigna-Humana merger could face a long regulatory delay. But it might get approved.
As rumors swirl that the two major health insurers are inching toward a merger, experts say antitrust agencies have grounds to block a deal — but may not be successful.
Rebecca Pifer • Dec. 4, 2023 -
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Where are all the nurses? Hospitals, advocates disagree on crisis
Hospitals and nursing unions clash on what’s driving sluggish application rates for open registered nurse positions — a lack of qualified candidates or a lack of interest.
Susanna Vogel • Nov. 21, 2023 -
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Preparing for the future: Hospital climate resilience plans challenged by cost, uncertainty
As extreme weather events caused by climate change ramp up in frequency, hospitals are struggling with financial and data challenges in disaster planning.
Emily Olsen • Nov. 7, 2023 -
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Blue Shield of California is promising a simpler, cheaper pharmacy benefits model. Can it deliver?
Big questions hang over the California health insurer's bold experiment — having five vendors carry out PBM functions previously performed by one — that could threaten BSCA's expected savings.
Rebecca Pifer • Updated Oct. 26, 2023 -
Rebecca Pifer/Healthcare Dive
GLP-1s for weight loss leave employers in a bind over coverage
Employers face a difficult decision over whether to cover pricey weight loss drugs that pits the health and wellbeing of their employees against the health of their bottom line.
Rebecca Pifer • Oct. 13, 2023 -
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Software overload could boost digital health M&A
Buyers of digital health products are overwhelmed with point solutions, which could accelerate merger and acquisition activity in a slowed funding environment, experts say.
Emily Olsen • Aug. 29, 2023 -
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Will the Biden administration’s short-term plan rule increase the uninsured rate?
Free-market advocates argue proposed restrictions on short-term plans will leave consumers without coverage. Health policy researchers aren’t so sure.
Rebecca Pifer • Aug. 14, 2023 -
Carol Highsmith. (2005). "The Apex Building" [Photo]. Retrieved from Wikimedia Commons.
New antitrust merger guidelines could have significant chilling effect on healthcare deals
Regulators have historically struggled to make a case against complex and non-traditional tie-ups. That could change with the new guidelines.
Rebecca Pifer • July 21, 2023 -
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States’ varying approaches complicate effort to determine impact of Medicaid redeterminations
Millions of people have been disenrolled from Medicaid, but it’s too early to get a full picture of redeterminations’ effect on vulnerable Americans, experts say.
Emily Olsen • July 13, 2023 -
Rebecca Pifer/Healthcare Dive
‘Hurtling into the future’: The potential and thorny ethics of generative AI in healthcare
Generative AI has roared onto the tech scene through the large language model backing ChatGPT. Companies are already deploying the algorithms in hospitals. Should healthcare be taking a pause?
Rebecca Pifer • April 21, 2023 -
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Delays in reporting led FDA to late cancer warning on breast implants, advocates say
Cases need to be better tracked, and the cancer risks should be discussed with patients prior to surgery, patient advocates and physicians said.
Elise Reuter • March 22, 2023
