Medicare Advantage is working for many, but it falls short for the sickest patients, according to Steven Gordon, MD, CEO of St. Charles Health System in Bend, Ore. 

HHS and the Treasury Department are providing $245 million in funding to the Colorado Division of Insurance for its reinsurance program and public option health plan.

UCare and the University of Minnesota have settled a dispute over the university's influence on the nonprofit health plan. 

Humana is challenging a CMS rule that would implement stricter auditing standards on Medicare Advantage plans. 

UnitedHealthcare says it did not breach its contract with Greenville, S.C.-based Prisma Health, and said the health system "coordinated a media effort to put pressure" on the insurance giant. 

Centene has moved to divest its overseas businesses and lost out on contract decisions in recent weeks. 

GoodRx has launched a new feature that allows providers to check a patient's insurance benefits when prescribing medications to better understand the final cost.

Wegovy, Novo Nordisk's expensive weight loss drug, could reduce the risk of cardiovascular events — but at a steep cost to insurers, Bloomberg reported Aug. 31. 

Health plans have historically struggled to deliver personalization that increases member engagement, improves care coordination, drives better outcomes and reduces costs. That’s despite spending 10% or more of their administrative budget on care management, according to McKinsey & Company, which also explained that payers are not deriving a return on investment from such programs. [1] As a result, health plans have missed opportunities to engage members outside high-risk populations, primarily because the technologies to achieve mass personalization were not adequately robust.

More than 5 million people have been disenrolled during the Medicaid redeterminations process. In some states, Medicaid recipients have filed legal challenges to the process, and whistleblowers are raising alarms. 

Wellcare, Centene's Medicare Advantage business, is partnering with the American Legion on Medicare Advantage plans designed to complement benefits veterans receive through the VA. 

CenterWell, Humana's older-adult focused primary care business, is expanding to in-home primary care. 

Greenville, S.C.-based Prisma Health is alleging UnitedHealthcare breached its confidentiality agreement with the system in the midst of contract negotiations. 

Elevance Health has faced legal action and hold-ups to proposed acquisitions in August. 

Cincinnati-based Bon Secours Mercy Health is suing Anthem Blue Cross Blue Shield of Virginia for $93 million, alleging the payer owes the health system millions in unpaid claims, according to a lawsuit filed in a Virginia circuit court.

Over a dozen states have excessive wait times for Medicaid call centers or high rates of call abandonment, according to CMS. 

Coverage for newly-approved RSV vaccines varies among insurers, The New York Times reported Aug. 25. 

Cigna Healthcare will exit some ACA markets in 2024 and expand to 15 new counties in North Carolina. 

The nation's largest health insurers are no longer just insurers — nearly all have restructured and grown into health services giants capable of paying for care and providing it too. 

Many Medicare Advantage beneficiaries disenroll from their plans within five years of enrolling, a study published Aug. 25 in JAMA Health Forum found.