_
Facebook-f Twitter Linkedin-in

Independent. Informative. Intelligent.

Health Care

Duke and Aetna iron out their differences

To the surprise of few, one suspects, Duke Health and Aetna have ended their quarrel and agreed to a new contract that keeps Aetna’s patients in-network when they use Duke’s facilities and personnel. Duke announced the deal on Friday and said only that throughout the talks, it’d “remained committed to...

By Ray Gronberg

October 6, 2025

Fitch calls Duke Health’s margins “compressed”

There’s a bit more to say about Duke Health and its finances, given the heat State Treasurer Brad Briner’s office is putting on the hospital system over its ongoing contract negotiations with Aetna. As recounted here Monday, the worry stems from Aetna’s role as administrator of the State Health Plan....

By Ray Gronberg

September 30, 2025

Duke in the crosshairs

Duke University and Duke Health are getting battered from all sides these days, politically speaking. My Business North Carolina colleague Chris Burritt reported recently on the impasse between Duke Health and Aetna, the CVS Health subsidiary that by some reckonings is the country’s fifth-larger health insurer by market share. Duke...

By Ray Gronberg

September 29, 2025

House GOP view on children’s hospital

House Republicans want to claw back all the money legislators have already appropriated for the proposed children’s hospital UNC Health and Duke Health want to build in Apex, House Speaker Destin Hall says. “Duke and UNC have a lot of money,” Hall said Tuesday during his post-session gaggle with the...

By Ray Gronberg

September 24, 2025

Children’s hospital figures in Senate-House standoff

Senators have tried a move to forestall impending Medicaid reimbursement-rate cuts to the funding of the proposed children’s hospital that UNC Health and Duke Health want to build in Apex. Their revision of House Bill 562 passed 47-0 and includes appropriations and spending cuts to free up money for the...

By Ray Gronberg

September 23, 2025

Paging Dr. Campbell

Before its summer break, the General Assembly passed and Gov. Josh Stein signed a bill that made it easier for physicians from out-of-state and overseas to come to North Carolina and practice their profession. House Bill 67 also include similar provisions for physician assistants coming from out of state, and...

By Ray Gronberg

September 5, 2025

Feds make deal over Medicare fraud

Federal prosecutors say a Charlotte company has agreed to pay a $1.4 million criminal penalty “to resolve a criminal investigation into a healthcare fraud and identity theft scheme.” The non-prosecution deal will keep Troy Health out of court, even though an FBI official said “the subjects in this case defrauded...

By Ray Gronberg

August 26, 2025

Court of Appeals rules on a western CON fight

With the House and Senate providing the crossover crunch this week and last that didn’t happen in early May, it’s been difficult for the other branches of government to get a word in edgewise. But the state Court of Appeals has certainly tried, via a couple of business-related decisions. The...

By Ray Gronberg

June 23, 2025

UNC Health sues Humana and Aetna over Medicare drug reimbursement cuts

UNC Health has sued two of the country’s top health insurers, seeking to recoup alleged shortfalls in Medicare Advantage reimbursements. Lawyers for the Chapel Hill-based health system filed complaints against Humana and Aetna in a Winston-Salem federal court on June 10. Both lawsuits allege the insurers “improperly and unilaterally” shortchanged UNC Health in reimbursements...

By Ray Gronberg

June 17, 2025

An impasse with CVS Caremark?

State Treasurer Brad Briner and his aides say the State Health Plan’s relationship with its pharmacy benefits manager, CVS Caremark, has “reached an untenable impasse.” Things have deteriorated to the point that the plan’s management is “evaluating its options to recover money owed and to determine its future relationship with Caremark,”...

By Ray Gronberg

June 6, 2025

UNC and ECU discord threatens NC Care

Back in 2023, legislative leaders touted their desire to use part of the state’s Medicaid-expansion bonus to fund a new healthcare collaboration between UNC Health and ECU Health. That year’s budget bill authorized spending up to $420 million on the so-called NC Care initiative, and actually appropriated the bulk of...

By Ray Gronberg

May 21, 2025

Strategy uncertain for reconciling PBM bills

With the House having already passed its bill to regulate pharmacy benefit managers, the Senate is on track to vote early next week on its own competing version. Senate Rules committee members agreed Thursday to send Senate Bill 479, the so-called SCRIPT Act, to the floor. That sets up a...

By Ray Gronberg

May 2, 2025

PBM bill clears House

House members voted 106-9 on Tuesday to pass their chamber’s version of a bill that would put some new restrictions on pharmacy benefits managers like CVS Caremark. Included in House Bill 163 is a ban on spread pricing, the practice of a PBM billing insurers for a drug anything else...

By Ray Gronberg

May 1, 2025

Berger on the children’s hospital

The Senate’s budget, passed on Friday, contains $638 million in additional state spending for the new children’s hospital the UNC and Duke health systems are planning to build somewhere in the Triangle. Counting prior appropriations, this will bring the total state subsidy for the project to $855 million. And if...

By Ray Gronberg

April 18, 2025

PBM update

The Senate’s getting into the pharmacy benefits manager game. On Thursday, the chamber’s Health Care committee endorsed Senate Bill 479, which on its face is an alternative to the House’s approach the last couple of sessions to the quarrels over PBMs and their role. Notably, the Senate bill omits a...

By Ray Gronberg

April 11, 2025

Facebook-f Twitter Linkedin