The No Surprises Act is succeeding in protecting patients from unexpected medical bills, but insurers and provider groups remain divided on what is driving rising costs tied to the Independent Dispute Resolution process and how regulators should respond. Since the…
Author: Jakob Emerson
CMS released Medicare Advantage star ratings on Oct. 9, showing an average score of 3.65 for 2026, compared to 3.92 last year. Plans were evaluated by the agency across 40 quality criteria spanning outcomes, experience, access, operations, and pharmacy. Plans…
Republican lawmakers are reviving proposals that failed to make it into the sweeping One Big Beautiful Bill Act, turning their focus to a trio of measures that could reshape how employers offer health benefits through Individual Coverage Health Reimbursement Arrangements,…
Optum’s Massachusetts-based subsidiary Atrius Health plans to acquire Acton Medical Associates, a 45-provider primary care group serving nearly 37,000 patients in the Boston area, according to a Sept. 25 filing from the Massachusetts Health Policy Commission. Atrius, a Newton-based physician…
A federal judge in Indiana has thrown out most claims in a whistleblower lawsuit accusing four insurers and six health systems of improperly billing the state’s Medicaid program, but left the door open for the case to continue. The lawsuit,…
Advertisement
Pittsburgh-based Highmark Health appointed Karen Hanlon as president, effective immediately. Ms. Hanlon will continue in her role as COO, according to an Oct. 8 Highmark Health news release. She is responsible for managing the operations of Highmark Health, Highmark Inc.,…
The Medicare Part D market is entering 2026 amid a period of contraction and recalibration. Premiums are ticking down on average, but plan options are shrinking as major insurers reassess the profitability of standalone drug plans under the effects of…
Leaders in healthcare are problem solvers. Our goal is to continually revolutionize healthcare by designing innovative products to address complex challenges and deliver better healthcare outcomes for our members and customers. Today’s healthcare solutions landscape is flooded with new products,…
Molina Healthcare is facing a proposed class-action lawsuit from an investor who alleges the company misled shareholders about rising medical costs and its 2025 earnings projections. The complaint, filed Oct. 3 in the U.S. District Court for the Central District…
Insurers that own providers can use internal transactions to inflate medical spending figures and reduce their rebate obligations under the ACA’s medical loss ratio rules, according to an analysis published Sept. 29 in Health Affairs. The analysis was published by…