Today's Top 20 Stories
  1. 40 Florida medical practices sue UnitedHealth

    Forty Florida medical practices are suing UnitedHealth over the pricing and payment of medical bills, Lawstreet Media reported May 4. 
  2. States ranked by increase in Medicaid, CHIP enrollment during pandemic

    Medicaid and CHIP enrollment increased by 22.1 percent between February 2020 and January 2022, according to a May 2 report from the Kaiser Family Foundation. 
  3. Regence BCBS Oregon names new vice president of sales

    Regence BlueCross BlueShield of Oregon named Renee Balsiger its new vice president of sales. 

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  1. Federal judge greenlights class action against Aetna over denied liposuctions

    A federal judge in California certified a class action lawsuit against Aetna on April 26 from at least 23 members who claim the CVS Health subsidiary denied them coverage for medically necessary liposuction treatments.
  2. 6 healthcare organizations urge Congress to permanently extend ACA tax credits

    The American Medical Association, American Hospital Association, AHIP and other healthcare organizations penned a letter May 3 to congressional leaders urging the permanent expansion of premium tax credits offered under the Affordable Care Act, which are set to expire at the end of this year.
  3. 5 steps payers should take when developing value-based care plans to ensure health equity 

    Payers have spent a decade transitioning toward value-based care plans in an effort to improve outcomes and costs for members. But plans that advance quality over quantity have done little to address health inequities, according to Josh Liao, MD, an associate professor of medicine at the University of Washington in Seattle.
  4. Bill expanding Medicaid for undocumented children clears Connecticut legislature

    Connecticut lawmakers passed a bill May 3 that expands Medicaid eligibility to children 12 and under whose parents meet the income criteria, regardless of immigration status, according to the Connecticut Mirror.

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  1. Rural residents benefiting more from enhanced ACA subsidies

    ACA premium subsidies included with federal COVID-19 relief are particularly beneficial to those living in rural areas, according to a May 3 report from the Urban Institute. 
  2. 5 recent contract disputes, agreements involving payers

    From the University of Mississippi Medical Center and UnitedHealthcare reaching a multiyear agreement, to a Maine physician group dropping Anthem, here are five recent contract disputes and agreements involving payers: 
  3. Humana names public health director as chief medical officer of Medicaid line in Kentucky

    Sarah Moyer, MD, has been named chief medical officer for Humana's Medicaid business in Kentucky, Humana Healthy Horizons, effective July 5.
  4. Bright Health reports major enrollment boost, $180M loss in Q1

    Bright Health Group reported massive enrollment growth across its commercial, Medicare Advantage and value-based lines, but recorded a net loss of more than $180 million in the quarter ending March 31, according to its first-quarter earnings report released May 4.

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  1. 'It really is frightening': Health plans brace as specialty drugs hit 50% of prescription spending

    Payers and pharmacy benefit managers say specialty drugs now account for 50 percent or more of the total prescription spending they manage, Forbes reported May 3. 
  2. 8 recent payer investments in value-based care

    With an estimated 65 million Americans covered under value-based care plans by 2025, payers are making big investments in care delivery models that focus on quality over quantity. From partnerships with providers to billion-dollar purchases of home care services, these are eight recent payer investments in value-based care:
  3. United Physicians, Agilon Health partner to build value-based primary care system for Medicare Advantage patients

    Bingham Farms, Mich.-based United Physicians and Agilon Health have entered a long-term partnership to transition United's primary care delivery system for Medicare Advantage patients to a full-risk value-based care model.
  4. Maine physician practice to drop Anthem; 10,000 patients affected

    Portland, Maine-based Fore River Urology is terminating its contract with Anthem, Maine Public Radio reported May 2. 
  5. MACPAC adds 4 members

    Government Accountability Office head Gene Dodaro appointed four new members to the Medicaid and CHIP Payment and Access Commission May 2. 
  6. 'Bring prior authorizations into the 21st century,' House lawmakers urge

    Four House lawmakers said it is "well past time to bring prior authorization into the 21st century," following an HHS report on Medicare Advantage denials.
  7. Centene CEO responds to questions over Magellan purchase that spurred California investigation

    Centene CEO Sarah London addressed alleged issues with Magellan's Medicaid pharmacy benefits rollout in January during the company's first-quarter earnings call April 26.
  8. UnitedHealthcare limits Aduhelm for all health plans: 'unproven and not medically necessary' 

    UnitedHealthcare plans will only pay for the controversial Alzheimer's drug Aduhelm for patients in clinical trials who have received prior authorization, according to a medical policy update filed May 1.
  9. Optum, Atrius Health's $236M merger receives final approval

    The Massachusetts Supreme Court approved a $236 million merger between UnitedHealth Group subsidiary Optum and Atrius Health on April 29, Atrius Health confirmed to Becker's.

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