Today's Top 20 Stories

  1. The top GLP-1 challenge facing UPMC's health plan

    Jakob Emerson -
    Insurers, health systems, state health plans and self-funded employers are all grappling with how to cover the high cost of GLP-1 medications, with some large organizations limiting coverage or dropping benefits entirely in 2024.

  2. States with largest Medicaid enrollment declines

    Rylee Wilson -
    With Medicaid redeterminations complete in most states, Medicaid enrollment has decreased by 14.3% from March 2023, according to KFF. 

  3. CVS Health sets quarterly dividend

    Andrew Cass -
    CVS Health's board of directors approved a $0.665 per-share dividend to be paid Nov. 1. 

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  1. The best-rated commercial health plans in each state: NCQA

    Rylee Wilson -
    Three commercial plans received five-star ratings from the National Committee for Quality Assurance. 

  2. 'We can't break things': How CareFirst guides AI startups

    Rylee Wilson -
    Healthworx, CareFirst Blue Cross Blue Shield's investment arm, aims to bridge the gap between an established insurer and scrappy startups, Managing Partner Doba Parushev said. 

  3. Former payer exec: Older adults should avoid Medicare Advantage in 2025

    Jakob Emerson -
    During the upcoming annual enrollment period, seniors should opt for traditional Medicare over Medicare Advantage, according to seasoned healthcare executive Stacy Mays.

  4. Cigna to trim Medicare Advantage offerings in 8 states 

    Jakob Emerson -
    Cigna Healthcare is exiting Medicare Advantage markets or making service area reductions in eight states for 2025, according to a Sept. 18 post from insurance brokerage firm Pinnacle Financial Services.

How one Midwest hospital is driving financial efficiency with interconnected systems

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  1. States ranked by average monthly ACA subsidy per enrollee 

    Jakob Emerson -
    West Virginia residents who receive health coverage on the ACA exchange receive the largest premium subsidies on average, while Minnesota residents receive the least, according to an analysis from KFF.

  2. Vance: Trump would make changes to ACA risk pools

    Rylee Wilson -
    Deregulating the individual insurance market would be part of former President Donald Trump's healthcare agenda in a second term, according to his running mate, Sen. JD Vance.

  3. The top-rated managed Medicaid plan in each state: NCQA

    Rylee Wilson -
    More Medicaid plans received 4 and 4.5 star ratings from the National Committee for Quality Assurance in 2024 than in 2023. 

  4. Best-rated Medicare Advantage plans in 2024: NCQA

    Jakob Emerson -
    The National Committee for Quality Assurance has named the best-rated Medicare Advantage plans of 2024 based on nearly 50 factors that include patient experience and clinical quality.

How one Midwest hospital is driving financial efficiency with interconnected systems

Sponsored
Major time savers can stem from single logins. That's how 1 hospital achieved a 50% reduction in month-end close time — read the short case study, here.

  1. The best-rated managed Medicaid plans of 2024: NCQA

    Jakob Emerson -
    The National Committee for Quality Assurance has named the best-rated managed Medicaid plans of 2024 based on nearly 50 factors that include patient experience and clinical quality.

  2. Texas system shutters Medicare Advantage plan

    Rylee Wilson -
    Southwestern Health Resources will not offer Medicare Advantage plans in 2025, D Magazine reported Sept. 17. 

  3. 4 payers among top 100 companies for hybrid work

    Jakob Emerson -
    Four insurers or their subsidiaries are among the top 100 companies in the U.S. for jobs  that consist of some remote work and some in-office work, according to FlexJobs.

  4. The state of Medicare Advantage in 2024

    Jakob Emerson -
    Medicare Advantage continues to grow fast, diversifying its membership of 33.8 million people, or about 55% of the total Medicare population, according to the Better Medicare Alliance's 2024 "State of Medicare Advantage Report."

  5. Why CenterWell is moving into Walmart

    Rylee Wilson -
    Primary care clinics focusing mainly on older adults are more likely to serve Black patients and those dually eligible for Medicare and Medicaid, a study from Humana found. 

  6. The best-rated Medicare Advantage plans in each state: NCQA

    Rylee Wilson -
    Two Medicare Advantage plans received the National Committee for Quality Assurance's five-star rating for 2024. 

  7. Cigna sues FTC over 'defamatory' PBM report

    Jakob Emerson -
    The Cigna Group's pharmacy benefit manager, Express Scripts, is suing the Federal Trade Commission and Chair Lina Khan over what it describes as an "unfair, biased, erroneous, and defamatory" report on pharmacy benefit managers released by the agency earlier this year. 

  8. Florida Blue, Baptist Health face October 1 split

    Rylee Wilson -
    Jacksonville, Fla.-based Baptist Health will be out-of-network with Florida Blue if the two sides do not reach a new contract deal by Oct. 1. 

  9. Health insurance executive moves | 2024

    Jakob Emerson -
    Payer executive moves reported by Becker's in 2024:

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