Enrollment in ACA marketplace plans fell in 49 of the 50 states plus D.C. between February 2025 and February 2026, according to CMS data published in late June. Ohio, Oklahoma and Arizona posted the steepest year-over-year declines, each shedding roughly…
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Three federal lawsuits are forming a tapestry of litigation related to the future of the ACA marketplace. In recent years, CMS has pitched rules focused on promoting marketplace “integrity” by tightening eligibility, altering enrollment periods and narrowing subsidy access, to…
Whether you manage performance across physician groups, hospital-based services or an entire health system, operating reliably at scale has become critical to protecting revenue and reducing risk. As complexity grows, so do the points where performance can break down. Staffing…
Nearly 5,000 independent pharmacies have filed a federal lawsuit against Prime Therapeutics, alleging the pharmacy benefit manager conspired with Cigna’s Express Scripts to suppress pharmacy reimbursement rates and increase fees in violation of federal antitrust law. The complaint was filed…
CMS is proposing to create a new payment pathway for algorithm-driven diagnostic software, including AI tools, as part of its 2027 Hospital Outpatient Prospective Payment System and Ambulatory Surgery Center proposed rule, issued July 2. The proposal marks CMS’ first…
The percentage of U.S. hospitals owning or jointly owning a health plan grew from 18.3% in 2018 to 27.2% in 2023, leaders from Boston-based Massachusetts General Hospital said in a research letter published in JAMA. Here is what to know:…
Nearly 97% of UnitedHealth’s in-home Medicare Advantage diagnoses were supported by a patient’s medical record in 2025, according to a review commissioned by the company. The findings are the latest in UnitedHealth’s efforts to defend HouseCalls, the in-home care program…
Mergers and acquisitions for payers, their subsidiaries and related businesses have been in full swing throughout 2026. The year has included nonprofit affiliations and large payers refining their portfolios. Here are 15 M&A updates from 2026: 1. Optum Financial, under…
Centene’s Ambetter is exiting Arkansas’ Medicaid expansion program, Arkansas Health and Opportunity for Me, in 2027. In a July 6 statement to Becker’s, the company attributed the decision to “current funding challenges.” Arkansas Health & Wellness — Centene’s managed care…
Blue Cross and Blue Shield of Louisiana has lost its most recent bid challenging how CMS calculated its 2025 Medicare Advantage star rating. On June 26, the U.S. Court of Appeals for the D.C. Circuit upheld a July 2025 district…