The No Surprises Act is tied to an 18% decline in out-of-pocket spending among adults with direct purchase private health insurance, according to a BMJ study published Aug. 27. The analysis was conducted by researchers from Harvard University and Mass…
Author: Jakob Emerson
Medicare Shared Savings Program Accountable Care Organizations generated record savings and continued to improve quality performance in 2024, CMS said Aug. 28. In 2023, the program saw $2.1 billion in net savings. Five notes: 1. Out of 476 ACOs, 75%…
New York City has proposed a new self-funded health plan administered by EmblemHealth and UnitedHealthcare for municipal employees, pre-Medicare retirees and their dependents. If approved by city regulators, the new plan would be effective on Jan. 1, according to an…
Cigna’s Evernorth is investing $3.5 billion in Shields Health Solutions, a specialty pharmacy company launched after Walgreens went private in August. Evernorth’s investment in Shields is in the form of preferred stock and is not expected to have a major…
Californians enrolled in Medicare Advantage are facing slower growth in healthcare costs compared to those in traditional Medicare, according to new research from the UCLA Center for Health Policy Research. Five notes: 1. Between 2013 and 2023, average monthly healthcare…
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Pittsburgh-based UPMC recorded an operating income of $111.2 million (1.3% operating margin) in the second quarter of 2025, driven in part by improved underwriting margins in the insurance division, according to its Aug. 28 financial report. Insurance enrollment revenue was…
UnitedHealthcare is suing Radiology Partners and its Arizona-based affiliate, Sonoran Radiology, alleging the companies have been “abusing” the No Surprises Act’s independent dispute resolution process and “funneling millions into the pockets of its private-equity owners.” The complaint, filed Aug. 8…
Dallas-based Baylor Scott & White has named Stephanie Motter as president of its health plan. Ms. Motter previously served as president of Indiana University Health’s Accountable Care Organization. Baylor Scott & White Health Plan serves nearly 500,000 members across employer-sponsored,…
The independent dispute resolution process created under the No Surprises Act has generated at least $5 billion in costs since its launch in 2022, largely due to high dispute volumes and provider wins, according to a study published Aug. 25…
Aetna is rolling out new claims cost control measures under its Claim and Code Review Program, beginning Sept. 1. The new claims editing policy applies to commercial, Medicare and student health members, the company said in June. Aetna may trigger…