Insurtech company Clover Health is scaling back its participation in the federal government’s Accountable Care Organization Realizing Equity, Access and Community Health program. “We have decided to significantly decrease the total number of participating physicians,” said President Andrew Toy during the company’s third-quarter earnings call this week.

Even though high patient volume has contributed positively to revenue for medical groups and physician practices in the third quarter, consistently high expenses have been eating into margins, putting such practices in a financial pinch.

Elevance Health, formerly Anthem, has entered into an agreement with CarepathRx, a portfolio company of Nautic Partners, to acquire BioPlus, a comprehensive specialty pharmacy, the insurer announced this week.  BioPlus provides a range of specialty pharmacy services for patients living with complex and chronic conditions, such as cancer, multiple sclerosis, hepatitis C, autoimmune diseases and […]

Rachael Grimaldi, cofounder and CEO of CardMedic, explains the company’s new app, which helps clinicians overcome barriers to communication and enhance healthcare equity.  

CEOs of both Oscar Health and Bright Health said this week during earnings calls that their companies are drawing back on their Medicare Advantage business.   Bright Health Group’s President and CEO Mike Mikan said Wednesday that the company is leaving the Affordable Care Act market and the MA market in all but California.

Pharmacy benefit manager Express Scripts, which had been taken to a Massachusetts court for allegedly overcharging for some injured workers’ prescriptions, has now settled the case for $3.2 million, according to a court document filed this week.

Replacing high-cost generics with cheaper medications that have the same clinical benefit could have cut down spending and saved patients about 88%, according to Johns Hopkins research published in JAMA Network Open. The use of generics is generally understood as a cost-saving practice, and insurers generally aim for high generic substitution rates as a cost-containment […]

Anna Lindow, Brave Health’s CEO and cofounder, talks about ways the virtual provider of behavioral healthcare will use a recent $40 million Series C raise.

Virtual care company TytoCare has launched a remote primary care offering for health plans and providers. 

Although hospital consolidation within markets has become a common practice, consolidation across markets is on the rise, with research in Health Affairs suggesting this may harm competition .