CMS is “voluntarily recalculating” 2027 Medicare Advantage quality bonus payment ratings, based on 2026 star ratings, following Clover Health’s successful challenge of the agency’s measures. CMS sent a letter informing health plans June 17. In its reevaluation, CMS will only…
Financial
ICHRA, reference-based pricing, narrow networks, direct contracting, cash pay — it seems you can’t escape these terms today in the employer health benefits market. Each is traceable back to the same gradual shift happening among the leverage structures that have…
As of fiscal 2023, nearly three-quarters of Medicaid beneficiaries were enrolled in a full-risk managed care organization, up from less than half in fiscal 2010. On June 15, the Medicaid and CHIP Payment and Access Commission, an agency that advises…
Many Blue Cross Blue Shield plans posted operating or underwriting losses in 2025 as medical and pharmacy costs climbed, but investment income lifted several of them to positive net income for the year. Combined profit margins across all BCBS plans sank to…
Commercial health plans are facing the steepest single-year cost increase in 17 years, with the group market trend projected to reach 9% in 2027, according to PwC’s annual medical cost trend report published June 11. PwC surveyed and interviewed actuaries…
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MultiPlan, now rebranded as Claritev, has been at the center of multiple sprawling legal challenges regarding its repricing tools. While some battles have been ongoing, others are just gaining steam. MultiPlan, a data analytics firm, offers payers tools to inform…
Humana has agreed to sell “all or substantially all” of its minority interest in hospice and palliative care provider Gentiva to a group of investors in a deal valued at $900 million. The transaction, announced June 10, closes out Humana’s…
CalOptima Health — a managed care health plan focused on covering low-income populations in Orange County, Calif. — has allocated close to $1 billion to provider rate increases since 2024. The board of directors approved $429.6 million from reserves to…
John Quinlivan, CEO of financially challenged Montgomery, Ala.-based Jackson Hospital, has warned of imminent closure unless BCBS Alabama agrees to raise reimbursement rates to match Baptist Medical Center South, located three miles away. “We filed a brief in our bankruptcy…
St. Louis-based Ascension has completed its acquisition of ambulatory surgery center operator AmSurg, expanding its footprint to 300 ASCs nationwide. The deal, valued at about $3.9 billion, marks a significant step in Ascension’s strategy to expand outpatient services and respond…