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A group representing nonprofit health plans is raising concerns over what it claims is a wide variation in Medicare Advantage risk adjustment scores across insurers, leading to what it calls a “gaming” of MA payments to the benefit of for-profit…

Executive Summary Payer-provider contracts are the backbone of financial and operational efficiency in the U.S. healthcare ecosystem. Seemingly straightforward, a payer-provider contract is the legal agreement between a healthcare payer and a provider that outlines the terms for delivering and…

Aledade’s ACOs accumulated $1 billion in savings through the Medicare Shared Savings Program in 2024. The network of independent primary care providers worked with about 11% of all MSSP beneficiaries, contributing nearly 20% of the program’s shared savings, according to…

CareSource and New York-based ElderServe Health have finalized their affiliation, effective Sept. 1. ElderServe Health, which offers Medicaid and Medicare to elderly or disabled New Yorkers, will no longer operate under RiverSpring Living, its former parent company, according to a…

SCAN Health Plan is expanding into Washington state and will enter new counties in California and Texas. Pending CMS approval, the nonprofit insurer will offer plans in Pierce, Spokane, and Thurston counties in Washington; Sacramento, Placer, Yolo, San Joaquin, Kings,…

Blue Cross Blue Shield of Wyoming is entering the Medicare Advantage market for 2026 coverage. In its inaugural year, WyoBlue Advantage will be available to Medicare-eligible residents in 22 of Wyoming’s 23 counties. The company will offer both a Medicare-only…

UnitedHealthcare’s prior authorization gold card program has seen a more than 40% increase in the number of qualifying provider groups in 2025, the company shared with Becker’s. Launched in October 2024, the program reduces prior authorization requirements in favor of…