Today's Top 20 Stories
  1. Humana, Longevity Health Plan partnering on new Medicare Advantage special needs plans

    Humana is launching new Medicare Advantage special needs plans with Longevity Health Plan in South Carolina and Georgia. 
  2. Illinois looks to create its own ACA exchange

    Proposed legislation would make Illinois the latest state to operate its own ACA exchange. 
  3. Health Alliance Plan, CareSource form joint venture

    Health Alliance Plan and CareSource have finalized an agreement to create a joint venture to expand Health Alliance Plan's Medicaid business in Michigan. 

Target the full spectrum of cardiometabolic conditions for better member outcomes, plan savings

Only 2.7% of US adults live a healthy lifestyle — & that costs health plans $500B a year. This approach supports better outcomes + employer savings.
  1. Aetna in the headlines: 9 recent updates

    CVS Health, parent company of Aetna, posted $2.1 billion in first quarter profits. The payer will also have a new executive taking the helm in September. 
  2. 7 payer M&A updates

    From CVS Health completing its acquisition of Oak Street Health, to Blue Cross Blue Shield of Michigan planning to bring on Blue Cross and Blue Shield of Vermont as a subsidiary, here are seven payer merger and acquisition updates Becker's has reported since March 29: 
  3. AMA president details 'Kafkaesque' prior authorization process

    American Medical Association President Jack Resneck Jr., MD, detailed in a post on the medical group's website the "Kafkaesque" prior authorization process that an unnamed insurance company allegedly put one of his patients through. 
  4. Bright Health Group names new CFO

    Bright Health Group has promoted Jay Matushak to CFO, effective May 12. 

3 ways to address No Surprises Act compliance challenges

A no-surprises approach to the No Surprises Act — get 3 strategies to improve compliance here.
  1. Medicare Advantage plans haunted by ghost networks, Senate Finance Committee says

    Medicare Advantage directories are plagued with inaccuracies, particularly for mental health providers, the Senate Finance Committee Chair Ron Wyden said. 
  2. 4 payers among top companies for women executives

    Four payers were named among DiversityInc's top companies for executive women. 
  3. Largest payer CEO salary increases in 2022

    UnitedHealth Group CEO Andrew Witty had the largest percentage increase in compensation between 2021 and 2022, according to regulatory filings. 
  4. 84% of group practices see increase in MA prior authorization requirements: MGMA

    Eight-four percent of group practices surveyed said prior authorization requirements have increased for Medicare Advantage over the past year, while less than 1 percent said those requirements have decreased, according to a May 3 survey from the Medical Group Management Association.

Target the full spectrum of cardiometabolic conditions for better member outcomes, plan savings

Only 2.7% of US adults live a healthy lifestyle — & that costs health plans $500B a year. This approach supports better outcomes + employer savings.
  1. In reversal, CVS expects double-digit Medicare Advantage growth in 2023

    CVS Health is expecting big growth in its Medicare Advantage membership by the end of 2023, setting a different tone compared to the company's disappointment in "low- to mid-single-digit-percentage" growth late last year.
  2. Ochsner Health Plan joins Alliance of Community Health Plans

    Ochsner Health Plan is now a member of the Alliance of Community Health Plans, which represents nonprofit, vertically-integrated health plans across 38 states and Washington, D.C.
  3. Viewpoint: Federal Medicaid work requirements are unconstitutional

    Forcing states to implement Medicaid work requirements would fail basic constitutionality tests, a group of health policy experts wrote in Health Affairs. 
  4. Centene to sell AI platform

    Centene has signed a definitive agreement to sell artificial intelligence platform Apixio to the private equity firm New Mountain Capital.
  5. Pennsylvania bans out-of-pocket costs for breast cancer screenings, genetic testing 

    Pennsylvania Gov. Josh Shapiro signed legislation May 1 that will require all payers operating in the state to eliminate any out-of-pocket costs for annual breast cancer screenings and genetic testing for high risk individuals.
  6. State audit questions CalOptima's surplus funds, hiring practices

    California regulators raised concerns about hiring practices and a surplus of funds at CalOptima Health, a managed care plan with nearly 1 million members. 
  7. Payers are concerned about gene-therapy drug costs: 5 things to know

    Payers are anticipating the cost of expensive new gene therapy drugs to be a significant issue in the coming years, according to a survey from the Pharmaceutical Strategy Group. 
  8. 26 state attorneys general urge Medicare to cover Alzheimer's treatments

    Twenty-six state attorneys general are asking Medicare to cover monoclonal antibody treatments for Alzheimer's disease. 
  9. Georgia signs state-run ACA exchange into law

    Georgia Gov. Brian Kemp signed legislation May 2 that establishes a state-managed ACA exchange, pending approval from CMS.

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