Today's Top 20 Stories
  1. Former Aetna Medicaid president named AmeriHealth Caritas CEO

    Kelly Munson has been named CEO of AmeriHealth Caritas. 
  2. CMS to terminate Illinois insurer's Medicare Advantage drug plan following low star ratings 

    CMS is terminating Chicago-based Zing Health's Medicare Advantage prescription drug plan at the end of 2024 following three consecutive years of star ratings below three stars.
  3. Virginia eliminates tobacco use surcharge under ACA plans

    Virginia has banned payers offering coverage on the ACA marketplace from including a surcharge for tobacco use, effective Jan. 1.

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  1. Managed care companies lagged behind other insurers in 2023: S&P 

    Managed Medicaid and Medicare Advantage insurers economically lagged behind other payers and the wider market in 2023, according to a Jan. 5 analysis from S&P Global Market Intelligence.
  2. Hospitals, payers get behind key points of CMS' Medicare Advantage proposed rule

    Hospital and payer groups were broadly supportive of proposed changes to Medicare Advantage prior authorization and broker compensation regulations. 
  3. What 5 recent studies found about Medicare Advantage

    Recent research on Medicare Advantage has tracked competition in local markets and investigated the rates of biosimilar drug uptake in both MA and traditional Medicare. 
  4. CVS Health in 'early innings' of Aetna integration, new president says

    Aetna President Brian Kane said CVS Health is still in the "early innings" of integrating the payer into the company, the Hartford Business Journal reported Jan. 8.

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  1. UnitedHealth Group in the headlines: 12 updates

    From accusing two former executives of stealing trade secrets to selling its health insurance and hospital operations in Brazil, here are 12 updates on UnitedHealth Group Becker's has reported since Dec. 12: 
  2. California fines Anthem Blue Cross for slow provider payments

    The California Department of Managed Health fined Anthem Blue Cross of California $690,000 for failure to reimburse providers and members in a timely manner during the second half of 2021. 
  3. Elevance Health sues HHS over Medicare Advantage star ratings changes

    Elevance Health and its insurance subsidiaries are suing HHS for "unlawful, and arbitrary and capricious" methodology changes to how Medicare Advantage and Part D star ratings are calculated.
  4. Defunct Friday Health Plans ordered to pay co-founder $450K

    A Colorado judge ordered defunct health insurance company Friday Health Plan to pay $450,000 to its co-founder David Pinkert, who sued the company for failing to pay his severance after he was fired in 2022, Law360 reported Jan. 3.  

How one Midwest hospital is driving financial efficiency with interconnected systems

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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. CMS to terminate Medicare Advantage drug contracts with 2 Centene plans

    CMS is terminating Centene's WellCare Medicare Advantage prescription drug plans in Arizona and North Carolina at the end of 2024 following three consecutive years of star ratings below three stars.
  2. The largest Medicare Advantage insurer in every state

    UnitedHealth group has the largest Medicare Advantage market share in 25 states, according to the American Medical Association. 
  3. CMS rejected 1 in 3 Medicare Advantage ads in 2023

    CMS rejected around a third of proposed Medicare Advantage television ads in 2023, Politico reported Jan. 5. 
  4. CVS' 2024 Medicare Advantage growth exceeds expectations

    CVS Health beat its expectations for growth during Medicare Advantage open enrollment, the company said. 
  5. The cities with the least competitive commercial insurance markets | 2023

    Blue Cross Blue Shield of Alabama has more than 90% of the commercial and exchange insurance market share in three cities in the state, the most highly concentrated markets in the U.S., according to the American Medical Association. 
  6. Medicare Advantage in the headlines: 9 recent updates

    Several mergers and acquisitions are afoot in Medicare Advantage. 
  7. Payer M&A deals to watch in 2024

    The new year has just begun, but already a significant payer transaction reportedly is in the works. 
  8. Memorial Hermann drops Humana Medicare Advantage

    Houston-based Memorial Hermann Health System is no longer in network with Humana's Medicare Advantage plans, effective Jan. 1.
  9. Centene spent $307M to settle state overbilling allegations in 2023

    A settlement agreement with South Carolina in late December brought the total amount that Centene paid in 2023 to resolve allegations it overbilled state Medicaid programs for pharmacy services to $307 million. 

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