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☆ Taking Account of Rising Health Care Costs
▼ + stars: | 2024-04-18 | by ( Josh Ocampo | ) www.nytimes.com time to read: +1 min

Navigating the health care system in the United States can often feel like being lost in a maze. For that reason, Chris Hamby, an investigative reporter, has devoted much of his five-year career at The New York Times to guiding readers through such dizzying questions. His latest article, which was published online this month, explored the complex subject of insurance bills. Last year, Mr. Hamby began investigating MultiPlan, a data firm that works with several major health insurance companies, including UnitedHealthcare, Cigna and Aetna. After a patient sees an out-of-network medical provider, the insurer often uses MultiPlan to recommend how much to reimburse the provider.

Persons: Chris Hamby, Hamby, MultiPlan Organizations: The New York Times, Times Locations: United States, Cigna, Aetna

☆ UnitedHealth beats on revenue despite impact from cyberattack
▼ + stars: | 2024-04-16 | by ( Ashley Capoot | In | ) www.cnbc.com time to read: +5 min

UnitedHealth Group reported better-than-expected revenue in its first-quarter results on Tuesday, though the company is still dealing with the fallout from the cyberattack on its subsidiary Change Healthcare. UnitedHealth reported revenue growth of close to 9% from $91.9 billion in the same period last year. Direct response efforts, like UnitedHealth's effort to restore Change Healthcare platforms, amounted to an impact of 49 cents per share in the quarter. Business disruption costs, like lost Change Healthcare revenue, amounted to 25 cents per share. In 2022, Optum completed a $13 billion merger with Change Healthcare, which offers tools for payment and revenue cycle management.

Persons: UnitedHealth, Optum, Andrew, UnitedHealthcare Organizations: UnitedHealth Group, Healthcare, LSEG, Change, U.S Locations: LSEG, Brazil

☆ Big corporations are quietly taking over your medical practice. Some doctors and experts say it's ruining healthcare.
▼ + stars: | 2024-04-11 | by ( ) www.businessinsider.com time to read: +17 min

UnitedHealth Group struck a deal in March to buy the nine-state doctor group of the struggling hospital system Steward Health Care. AdvertisementDoctors are hot commoditiesIt's tough to lump the many buyers of medical practices together, as they're pursuing different strategies. Insurers like UnitedHealthcare and CVS' Aetna are required by federal law to spend most of the money they collect in premiums on medical care. Plus, running a modern medical practice is expensive, requiring investments in staffing, technology, and electronic health records. Advertisement"The corporate practice of medicine is the reason why healthcare costs are out of control," Li said.

Persons: —, UnitedHealth's Optum, That's, UnitedHealth, there's, They're, Farzad Mostashari, UnitedHealth's chokehold, Chas Roades, Yashaswini Singh, Singh, Roades, Nick Jones, they're, Optum, Jones, Mitch Li, Li, Michelle Cooke, Cooke, she's, Ben Bowman, Bowman Organizations: Service, UnitedHealth, Health Care, CVS Health, Walgreens, Physicians, Research, US Justice Department, CVS, Aetna, Brown University, Harvard Medical School, Oregon Medical Group, JAMA, Amazon, The Washington Post, Federal Trade Commission, US Department of Justice, Department of Health, Human Services, Oregon State, Corvallis Clinic Locations: Oregon, New York, UnitedHealth, Optum, California, The, Atlanta

☆ One Medical patients are stuck in the middle of a fight between a hospital system and the biggest US health insurer
▼ + stars: | 2024-03-13 | by ( ) www.businessinsider.com time to read: +5 min

Read previewSome One Medical patients may soon lose affordable access to their doctors because of an ongoing clash between a preeminent New York hospital system and the country's biggest health insurer. For months, Mount Sinai Health System and UnitedHealthcare have been fighting over payments. Mount Sinai is also asking for higher rates in the middle of its three-year contract, which isn't typical, said Fitch analyst Brad Ellis. AdvertisementUnitedHealthcare argues that Mount Sinai demanded "outlandish" price hikes that would increase healthcare costs by $574 million over the next three years. The Mount Sinai representative said close to 100,000 patients, including One Medical patients, have been affected.

Persons: —, Sinai, UnitedHealthcare, Mount Sinai, Meggi Carr, Brad Ellis, it's, Mount Organizations: Service, Sinai Health, Business, Amazon, Fitch, UnitedHealthcare, Mount Locations: New York, Sinai, Mount, Mount Sinai, New York City, UnitedHealthcare

☆ Outages from cyberattack at UnitedHealth's Change Healthcare extend to seventh day as pharmacies deploy workarounds
▼ + stars: | 2024-02-27 | by ( Ashley Capoot | In | ) www.cnbc.com time to read: +7 min

Change Healthcare's systems are down for the seventh day after a cyber threat actor gained access to its network last week. Change Healthcare offers tools for payment and revenue cycle management, and its system outages have disrupted operations in pharmacies and health systems across the country. Change Healthcare merged with Optum in 2022. Rising number of health-care cyberattacksThe attack on Change Healthcare comes after 2023 set a grim record for health-related cybercrime. Impact of Change Healthcare's breachUnitedHealth has not specifically disclosed exactly which Change Healthcare systems have been affected, but the fallout from the cyberattack has caused a ripple of problems across the U.S. health-care system.

Persons: UnitedHealth, John Riggi, Riggi, Cliff Steinhauer, Steinhauer, Cary Brazeman, Brazeman, hadn't Organizations: New York Stock Exchange, UnitedHealth Group, U.S . Securities, Exchange, Change Healthcare, Change, Optum, Healthcare, Palo Alto Networks, Google, CNBC, American Hospital Association, National Cybersecurity Alliance, CVS Health, Walgreens Locations: U.S, Palm Springs

☆ A Cyberattack on a UnitedHealth Unit Disrupts Prescription Drug Orders
▼ + stars: | 2024-02-26 | by ( Reed Abelson | ) www.nytimes.com time to read: +1 min

A cyberattack on a unit affiliated with UnitedHealthcare, the nation’s largest insurer, has disrupted drug prescription orders at thousands of pharmacies for nearly a week. The assault on the unit, Change Healthcare, a division of United’s Optum, was discovered last Wednesday. The attack appeared to be by a foreign country, according to two senior federal law enforcement officials, who expressed alarm at the extent of the disruption on Monday. UnitedHealth Group, the conglomerate, said in a federal filing that it had been forced to disconnect some of Change Healthcare’s vast digital network from its clients, and as of Monday, had not been able to restore all of those services. The company was acquired by UnitedHealth Group for $13 billion in 2022.

Organizations: UnitedHealthcare, UnitedHealth, UnitedHealth Group Locations: United’s

☆ UnitedHealth subsidiary Change Healthcare down for a fourth day following cyberattack
▼ + stars: | 2024-02-24 | by ( Ashley Capoot | In | ) www.cnbc.com time to read: +2 min

Change Healthcare's systems are down for a fourth straight day after parent company UnitedHealth Group disclosed that a suspected cybersecurity threat actor gained access to part of its information technology network on Wednesday. UnitedHealth, the biggest health-care company in the U.S. by market cap, owns the health-care provider Optum, which merged with Change Healthcare in 2022. Optum services more than 100 million patients in the U.S., according to its website, and Change Healthcare offers solutions for payment and revenue cycle management. ET Saturday, Change Healthcare said the disruption is expected to continue "at least" through the day. The AHA declined to comment on the Change Healthcare cyberattack.

Persons: UnitedHealth, We're, CISA Organizations: UnitedHealth Group, Healthcare, U.S . Securities, Exchange Commission, CNBC, CVS Health, CVS, American Hospital Association, AHA, Department of Health, Human Services, FBI, Infrastructure Security Agency, HHS Locations: U.S

☆ 2 startups posted big membership growth in the lucrative senior health plan business — after other young insurers failed
▼ + stars: | 2024-02-21 | by ( ) www.businessinsider.com time to read: +6 min

Just a few years ago, a crop of venture-backed health insurance startups embarked on planting a flag in the crowded but lucrative health plan business for seniors. Bright Health, which has exited the insurance business entirely as of this year, sold its Medicare Advantage plans in December. However, there are signs that the Medicare Advantage business isn’t as much of a goldmine as it used to be. It takes an enormous amount of capital to grow big in the insurance business, Fidel said. Its Medicare Advantage membership totals about 4 million.

Persons: haven’t, Stephens, underscoring, Oscar Health, Clover, Cowen, Gary Taylor, didn’t, Scott Fidel, it’s, they’ll, Fidel, UnitedHealthcare Organizations: Alignment Healthcare, Medicare, Business, Bright, Oscar, Services, Humana, CVS Health, Aetna, CVS Locations: California, New Jersey

☆ The red-hot health-plan business for seniors is finally cooling off
▼ + stars: | 2024-02-06 | by ( ) www.businessinsider.com time to read: +6 min

Read previewHealth insurance giant Cigna is exiting the lucrative senior business that's been a boon to insurers' bottom lines for years. It's a sign that the glory days of Medicare Advantage might be coming to an end. Cigna's senior business isn't the biggest, but it's also nothing to sneeze at. In January, Humana, the second-largest Medicare Advantage insurer with 6 million members, slashed its profit projections because of these costs. AdvertisementIn late 2023, rumors swirled that Cigna was looking to sell its Medicare Advantage plans so it could pull off a merger with Humana—the second-largest Medicare Advantage insurer.

Persons: —, that's, Cigna, it's, It's, David Cordani, Cordani, Gary Taylor, Cowen, Taylor, Dean Ungar, Humana, Ungar Organizations: Service, Health Care Service Corp, Medicare, Business, Kaiser Family Foundation, Competition, Humana, Moody's Investors Service Locations: Illinois

☆ Spora Health's founder painted a rosy portrait of his healthcare startup. The reality is more complicated.
▼ + stars: | 2023-10-30 | by ( ) www.businessinsider.com time to read: +14 min

The way Dan Miller told it, his startup Spora Health was crushing it, providing high-quality care to "thousands" of people online. The startup had secured at least one big contract, with Apple, according to three former Spora employees and another source close to Spora. Four of them told Insider they either no longer worked with Spora or hadn't seen Spora patients in a year. Two doctors listed on Spora's website as "featured Spora providers" also told Insider that they no longer worked for the startup. Another former clinician said she only ever treated a handful of Spora patients.

Persons: Dan Miller, Miller, Spora, it's, UnitedHealthcare, Aetna didn't, paychecks, hadn't, he's, It's, —, we've, " Miller, Shelby Livingston, Rob Price, Emmalyse Brownstein, Ryan Pickrell, Gloria Dawson, Stephanie Hallett, Alcynna Lloyd, Hayley Peterson Organizations: Company, TechCrunch, Spora, US Securities and Exchange Commission, Apple, Aetna, Stanford Graduate School of Business, Human Ventures, MaC Venture, SEC Locations: Spora, Level's, slivingston@insider.com

☆ Ozempic Boom Is an Opportunity for Health Insurers
▼ + stars: | 2023-10-20 | by ( David Wainer | ) www.wsj.com time to read: 1 min

WSJ’s Daniela Hernandez breaks down the science of how diabetes drugs work—and how they could change psychiatry. Photo illustration: Elizabeth SmelovYou would think a new class of high-price weight loss drugs taken by millions of Americans would be a problem for health insurers. But it is more complicated than that: Some insurance giants actually stand to profit from the Ozempic craze. The industry has been calling out the costs of GLP-1 drugs, which are used for both diabetes and obesity. But federally supported Medicare and Medicaid still don’t cover the drugs for obesity, and much of the commercial market is self-insured.

Persons: WSJ’s Daniela Hernandez, Elizabeth Smelov, Aetna

ATLANTA (AP) — The state of Georgia will start paying for gender-affirming health care for state employees, public school teachers and former employees covered by a state health insurance plan, settling another in a string of lawsuits against Georgia agencies aiming to force them to pay for gender-confirmation surgery and other procedures. The December lawsuit argued the insurance plan illegally discriminated by refusing to pay for gender-affirming care. But Brown said Thursday's settlement requires the health plan to pay for care deemed medically necessary for spouses and dependents as well as employees. That means the health plan could be required to pay for care for minors outside the state even though it's prohibited in Georgia. “The plan can’t treat the care any differently from other care that’s not available in the state,” Brown said.

Persons: “, ” David Brown, Micha Rich, Benjamin Johnson, Brown, it's, ” Brown, John Doe, ” Rich, Jeff Amy Organizations: ATLANTA, State, of Community Health, Civil, University, Georgia, University of Georgia, Department of Community Health, Circuit, Appeals, Georgia Department, School District, Family, Children Services, U.S, Opportunity Commission Locations: Georgia, Atlanta, Clayton County, Houston, Houston County, U.S, Bibb, Macon ., Paulding County, North Carolina, Wisconsin, West Virginia, Iowa, Florida, Arizona

☆ These 5 strategies can help you avoid surprise medical bills
▼ + stars: | 2023-09-18 | by ( Sponsor Post | Created Unitedhealthcare S Surest With Insider Studios | ) www.businessinsider.com time to read: +6 min

Other recent regulations require hospitals to post prices online, and while these efforts offer important protections for people, there are various other ways to help avoid an unexpected medical bill. To help avoid that, confirm with your health plan that any services or tests are covered under your benefits. Negotiate surprise billsIn the event of a surprise bill, there are several steps to pursue. No one wants a surprise medical bill. Learn more about how to avoid surprise medical bills at surest.com.

Persons: Donna O'Shea, — Organizations: Population Health, Insider Studios Locations: surest.com

☆ Clarence Thomas purchased his luxury RV with the help of a wealthy former healthcare executive: NYT
▼ + stars: | 2023-08-05 | by ( Charles R. Davis | ) www.businessinsider.com time to read: +3 min

Supreme Court Justice Clarence Thomas purchased a $267,000 RV with the help of a wealthy friend. A spokesperson for the Supreme Court did not immediately respond to a request for comment. In a statement to the Times, Welters said he had provided Thomas a loan so he could buy the RV. But Welters refused to say how much money he had lent the Supreme Court justice, nor on what terms. The revelation comes amid a push to impose new ethics requirements on Supreme Court justices.

Persons: Clarence Thomas, Thomas, Anthony Welters, Welters, Barack Obama, Ginni, —, Reagan, Beatrice, Obama, Harlan Crow, Sen, Dick Durbin Organizations: The New York Times, Service, Supreme, New York Times, Times, Historical Society, Illinois Democrat Locations: The, Wall, Silicon, America, Illinois

☆ ChenMed just tapped a UnitedHealthcare veteran to take over as the clinic company confronts financial pressures
▼ + stars: | 2023-07-20 | by ( ) www.businessinsider.com time to read: +4 min

The family behind primary-care company ChenMed is stepping back from their leadership roles. He will bring on an almost entirely new leadership team, effective August 1. "The Chen family remains owners of the ChenMed company, and we will no longer be directing company operations," Chris Chen told staff. As a private company, ChenMed does not disclose its financials. During the meeting Thursday, Chris Chen told staff that the family and leadership team have "decided to keep the ChenMed brands together."

Persons: Steve Nelson, ChenMed, Chen, Nelson, Chris Chen, Steve Nelson ChenMed, Steve, Chris Chen's, Dr, Gordon Chen, James Chen, Mary Chen, Stephanie Chen, Jessica Chen, Shelby Livingston Organizations: Humana Locations: slivingston, insider.com

☆ UnitedHealth stock jumps after earnings top estimates despite rising medical costs
▼ + stars: | 2023-07-14 | by ( Annika Kim Constantino | ) www.cnbc.com time to read: +4 min

UnitedHealth Group' s stock price jumped Friday after the health-care conglomerate reported second-quarter revenue and adjusted earnings that topped Wall Street's expectations despite rising medical costs. UnitedHealth Group is the biggest health-care company in the U.S. by market cap and revenue, and is even bigger than the nation's largest banks. Given its size, UnitedHealth Group is considered a bellwether for the broader health insurance sector. UnitedHealth Care said that was driven by the previously noted uptick in elective surgeries and outpatient care activity, primarily among seniors. But UnitedHealth Group executives indicated that the trend may be reversing.

Persons: UnitedHealth, –, John Rex, Rex, Goldman Sachs Organizations: UnitedHealth, Refinitiv, Healthcare, Analysts, Goldman, Rex . Insurance Locations: Minnesota, U.S

☆ Clover Health, which bet its technology would disrupt health insurance, will outsource health-plan operations and cut jobs to help it turn a profit
▼ + stars: | 2023-04-17 | by ( ) www.businessinsider.com time to read: +3 min

Clover Health bet its technology would disrupt health insurance, but it's struggled with losses. Now it's cutting jobs and it plans to outsource some health-plan operations to lower its costs. Clover Health, an insurance upstart that bet its technology could transform healthcare for seniors, now plans to outsource basic functions like paying medical claims. The Tennessee-based health insurer said Monday that it will shift the responsibility of its core operations to UST HealthProof, a company that handles administrative operations for health plans. It's not unusual for small health insurers to outsource some health-plan operations.

☆ People Can't Get Ozempic, New Weight-Loss Drugs Because of Broken Healthcare System
▼ + stars: | 2023-04-13 | by ( ) www.businessinsider.com time to read: +15 min

Wegovy is just one of a wave of revolutionary weight-loss drugs, which also includes the buzzy Ozempic, that represents a watershed moment for obesity treatment. Demand for weight-loss drugs is surgingDoctors and healthcare professionals searched for a healthy, safe, and effective weight-loss solution for years before the drugs, known collectively as GLP-1 agonists, exploded on the scene. If there is one key that could unlock access to expensive weight-loss drugs for Americans, it's Medicare. Expanding coverage for Ozempic and other weight-loss drugs for just a small segment of the population could cost Medicare up to $26.8 billion a year. Patients lose outYears from now, patients may have an easier time getting their hands on weight-loss drugs.

☆ Devoted Health quietly blew past other insurance upstarts in the red-hot market for seniors
▼ + stars: | 2023-04-05 | by ( ) www.businessinsider.com time to read: +5 min

While last year was a bloodbath for some young health insurers, Devoted Health ended 2022 relatively unscathed. Several newly public health insurers have struggled with losses, and some have been forced to retrench to stay afloat. Devoted has won more Medicare Advantage members in 2023 than competitorsExecutives of Devoted Health's rivals. Clover Health; Bright Health; Oscar Health; Olivia Reaney/Business InsiderInsider's analysis of the latest federal enrollment data found that Devoted had 126,287 Medicare Advantage members as of March 1. Bright had 122,371 Medicare Advantage members at the two California health plans it owns, while Alignment Healthcare had about 109,221 Advantage members, according to Insider's analysis.

☆ Dreaded Medical Paperwork Required by Health Insurers to Be Trimmed
▼ + stars: | 2023-03-29 | by ( Anna Wilde Mathews | Stephanie Armour | ) www.wsj.com time to read: 1 min

UnitedHealthcare said it would cut its use of the prior authorization process. The paperwork required by health insurers to get many medical procedures or tests—one of the biggest gripes of doctors and patients—is getting rolled back. UnitedHealth Group Inc.’s UnitedHealthcare, the largest health insurer in the U.S., said it would cut its use of the prior authorization process. Starting in the third quarter, it will remove many procedures and medical devices from its list requiring the signoff.

☆ States and healthcare organizations join forces to help people prepare for Medicaid redeterminations
▼ + stars: | 2023-03-06 | by ( Sponsor Post | Created Insider Studios With Unitedhealthcare | ) www.businessinsider.com time to read: +6 min

As many as 18 million Americans may lose Medicaid coverage this year. Over the past three years, Medicaid recipients remained eligible thanks to a Congressional bill that provided funds to maintain continuous Medicaid coverage. But this April marks the end of this pandemic-era policy that helped people maintain their Medicaid coverage. That means the continuous enrollment provision will expire and states will return to their pre-pandemic policies of requiring people to renew their Medicaid coverage annually. Any individuals or families who lose Medicaid coverage through this redetermination process will need assistance securing replacement health insurance coverage.

☆ A top-5% fund manager shares 4 reasons why he's getting optimistic about the economy after hiding nearly half of his assets in cash last summer — and details 6 of his favorite stocks to buy now
▼ + stars: | 2023-02-22 | by ( James Faris | ) www.businessinsider.com time to read: +7 min

Leading fund manager Jeff Muhlenkamp put about half of his fund into cash last summer. Last summer, Jeff Muhlenkamp was so concerned about the US economy that he put nearly half of his fund's assets into cash. But in recent months, Muhlenkamp has moved more money into select stocks — even though he acknowledges that there are still lingering risks for stocks and the economy. "You're seeing buyers come back into the market," Muhlenkamp said. Lastly, Microsoft is like Apple in that it's a mature mega-cap company with profitable businesses that produce tons of cash, Muhlenkamp said.

☆ The arms race for doctors is on. CVS is hoping a $10.6 billion deal will help it compete with Amazon and UnitedHealthcare.
▼ + stars: | 2023-02-08 | by ( ) www.businessinsider.com time to read: +5 min

CVS Health just said it wants to buy primary-care company Oak Street Health for $10.6 billion. CVS Health is finally entering the arms race among health insurers and big retailers to employ doctors. Oak Street gets most of its revenue from relationships with CVS-owned Aetna rivals Humana, Centene, and UnitedHealthcare. And though Aetna is a big Medicare Advantage player, it also has millions of members who get insurance through their employers. Mike Pykosz, Oak Street Health CEO Oak Street HealthGuertin also noted that the improved health outcomes and better experience provided in Oak Street clinics would help Aetna hold onto its Medicare Advantage patients.

☆ See the 12-slide presentation that a health-insurance startup used to land $58 million after its public competitors tumbled
▼ + stars: | 2023-02-08 | by ( Rebecca Torrence | ) www.businessinsider.com time to read: +4 min

Angle Health wants to use tech to transform health insurance where other upstarts have failed. Angle Health raised $58 million to disrupt employer-sponsored health benefits using this pitch deck. Companies like Oscar Health, Clover Health, and Bright Health raked in investor cash on the promise that they could transform health plans with tech, and each went public in 2021 at a lofty valuation. Angle Health provided Insider with the pitch deck it used to raise $58 million in Series A funding from Portage and other investors. Here's the pitch deck Angle Health used to land a $58 million Series A.

☆ The era of health insurance disruptors is over
▼ + stars: | 2023-02-02 | by ( ) www.businessinsider.com time to read: +10 min

Today, they're mostly the poster children of just how challenging it is to break into the insurance industry. Clover Health; Bright Health; Oscar Health; Olivia Reaney/Business InsiderOscar, founded in 2012, and Bright, in 2015, set out to sell health plans to people buying coverage through the Affordable Care Act marketplace. Elevance Health, the parent company of Anthem health plans, is No. Health insurance remains overly complex and mind-numbingly frustrating. Established health insurers haven't been able to stem the rise in health costs, which are mostly determined by the prices for medical care.

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