Today's Top 20 Stories
  1. Aetna in the headlines: 7 recent updates

    CVS Health is expecting Aetna's Medicare Advantage star ratings to hurt its 2024 outlook, and the payer is investing in more value-based care. 
  2. 7 key CMS policy updates in the first half of 2023

    CMS has finalized or proposed several policy changes in 2023, including stricter audits of Medicare Advantage plans, changes to prior authorization and regulations aimed at drug prices. 
  3. Minnesota passes preventive care requirements law

    Minnesota Gov. Tim Walz signed legislation requiring insurers to cover preventive services after a Texas judge struck down some requirements for payers to cover preventive care at no cost to members under the ACA.  

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  1. States ranked by total residents with self-funded health coverage

    California has the most residents enrolled in self-insured health plans through an employer, while Wyoming has the least, according to a health coverage report published by insurance trade group AHIP in April.
  2. States ranked by total Medicare Advantage members

    Eight states have at least 1 million residents enrolled in Medicare Advantage plans, according to a health coverage report published by insurance trade group AHIP in April.
  3. The payer mix of each state in 2023

    Utah has the highest percentage of residents enrolled in commercial health plans (68 percent), New Mexico has the highest percentage enrolled in Medicaid (28 percent), and Maine has the highest percentage enrolled in Medicare (22 percent), according to a health coverage report published by insurance trade group AHIP in April.
  4. Appeals court rules Florida hospitals' payment dispute case against Cigna can proceed

    Eight Florida hospitals can pursue a lawsuit against Cigna after a federal appeals court on May 25 overturned a lower court's ruling in favor of the payer. 

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  1. Washington state directs Regence BlueShield to correct ambulance balance billing claims

    The Washington state insurance commissioner is directing Cambia Health Solutions, parent company of Regence BlueShield, to correct claims in which members were "balance billed" for ambulance services. 
  2. How payer, for-profit health system CEOs compare on pay

    Most major payer CEOs earned millions more than for-profit health system leaders in 2022. 
  3. Why UPMC's health plan saw 12% year-over-year membership growth

    Pittsburgh-based UPMC's insurance services division grew from 4,033,737 total members in the quarter ended March 31, 2022, to 4,505,128 members in the quarter ended March 31, 2023, according its financial report released May 25. 
  4. Medicare Advantage star ratings decline will cost CVS Health up to $1B in revenue

    CVS Health is expecting Aetna’s operating income to decrease by up to $1 billion next year because the number of its Medicare Advantage members in four star plans has dropped significantly since last year, according to regulatory documents filed May 25 with the Securities and Exchange Commission.

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

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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. Health insurance executive moves | 2023

    Payer executive moves reported by Becker's in 2023:
  2. 3 payers recognized as climate leaders in 2023, per USA Today

    Elevance Health, Cigna and CVS Health were recognized on USA Today's inaugural list of America's Climate Leaders in 2023, which was developed with Statista and published May 23.
  3. Commonwealth Care Alliance names general counsel, SVP of public affairs

    Commonwealth Care Alliance has appointed Elizabeth Gianini as senior vice president of public affairs and David Weader as senior vice president and general counsel. 
  4. 8 payers among Forbes' best employers for new graduates in 2023

    Forbes recognized eight payers on its annual list of "America's Best Employers for New Grads," released May 23. 
  5. Average hospital payer mix in every state

    On average, Wisconsin hospitals have the highest commercial payer mix in the country (78.1 percent), while Washington, D.C., hospitals have the lowest (47.9 percent), according to an April analysis from Definitive Healthcare.
  6. CBO: Uninsured rate to reach 10 percent by 2033

    More people will be uninsured in 2033 than in 2023 as Medicaid continuous coverage unwinds, and extended marketplace subsidies could be discontinued, according to the Congressional Budget Office. 
  7. Walgreens wants Humana's $642M arbitration award vacated

    Walgreens is asking a judge to overturn an arbitrator's $642 million award to Humana in a drug-pricing dispute between the companies. 
  8. How four major payers compare on price transparency

    Payers' price transparency files vary widely by size and number of billing codes, an analysis published in Health Affairs found. 
  9. Health advocacy groups urge Florida governor to pause Medicaid purge

    More than 50 health advocacy groups and other organizations are calling on Florida Gov. Ron DeSantis to pause Medicaid redeterminations after about 250,000 residents were disenrolled from the program.

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