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Illinois looks to create its own ACA exchange
Proposed legislation would make Illinois the latest state to operate its own ACA exchange. -
Aetna in the headlines: 9 recent updates
CVS Health, parent company of Aetna, posted $2.1 billion in first quarter profits. The payer will also have a new executive taking the helm in September. -
AMA president details 'Kafkaesque' prior authorization process
American Medical Association President Jack Resneck Jr., MD, detailed in a post on the medical group's website the "Kafkaesque" prior authorization process that an unnamed insurance company allegedly put one of his patients through. -
Medicare Advantage plans haunted by ghost networks, Senate Finance Committee says
Medicare Advantage directories are plagued with inaccuracies, particularly for mental health providers, the Senate Finance Committee Chair Ron Wyden said. -
Largest payer CEO salary increases in 2022
UnitedHealth Group CEO Andrew Witty had the largest percentage increase in compensation between 2021 and 2022, according to regulatory filings. -
84% of group practices see increase in MA prior authorization requirements: MGMA
Eight-four percent of group practices surveyed said prior authorization requirements have increased for Medicare Advantage over the past year, while less than 1 percent said those requirements have decreased, according to a May 3 survey from the Medical Group Management Association. -
In reversal, CVS expects double-digit Medicare Advantage growth in 2023
CVS Health is expecting big growth in its Medicare Advantage membership by the end of 2023, setting a different tone compared to the company's disappointment in "low- to mid-single-digit-percentage" growth late last year. -
Ochsner Health Plan joins Alliance of Community Health Plans
Ochsner Health Plan is now a member of the Alliance of Community Health Plans, which represents nonprofit, vertically-integrated health plans across 38 states and Washington, D.C. -
How virtual companions can close care gaps and reduce costs
Payers face multiple industry headwinds, ranging from healthcare worker shortages to the high prevalence of chronic conditions, disjointed member experiences and disengaged members. These headwinds result in gaps in care, unnecessary emergency department (ED) readmissions and other issues. -
Viewpoint: Federal Medicaid work requirements are unconstitutional
Forcing states to implement Medicaid work requirements would fail basic constitutionality tests, a group of health policy experts wrote in Health Affairs. -
Pennsylvania bans out-of-pocket costs for breast cancer screenings, genetic testing
Pennsylvania Gov. Josh Shapiro signed legislation May 1 that will require all payers operating in the state to eliminate any out-of-pocket costs for annual breast cancer screenings and genetic testing for high risk individuals. -
State audit questions CalOptima's surplus funds, hiring practices
California regulators raised concerns about hiring practices and a surplus of funds at CalOptima Health, a managed care plan with nearly 1 million members. -
Payers are concerned about gene-therapy drug costs: 5 things to know
Payers are anticipating the cost of expensive new gene therapy drugs to be a significant issue in the coming years, according to a survey from the Pharmaceutical Strategy Group. -
26 state attorneys general urge Medicare to cover Alzheimer's treatments
Twenty-six state attorneys general are asking Medicare to cover monoclonal antibody treatments for Alzheimer's disease. -
Georgia signs state-run ACA exchange into law
Georgia Gov. Brian Kemp signed legislation May 2 that establishes a state-managed ACA exchange, pending approval from CMS. -
Montana judge halts rule requiring prior authorization for Medicaid-paid abortions
A Montana judge is temporarily halting a rule that would require prior authorizations for Medicaid-paid abortions, the Daily Montanan reported May 1. -
UnitedHealthcare ordered to pay Envision $91M in billing dispute
Arbitrators sided with physician services company Envision Healthcare in its dispute with UnitedHealthcare over allegations the payer breached their contract by reducing reimbursement rates. -
Medicare Advantage in the headlines: 7 recent updates
Bright Health is moving to sell the last of its Medicare Advantage business, and new enrollments are boosting payers' first-quarter earnings. -
How Blue Cross Blue Shield of Arizona is changing behavioral health numbers and narratives
I have held titles throughout my life and career that reinforce my commitment to healthcare and caring. I’m the chief medical officer at Blue Cross Blue Shield of Arizona, former director of the Arizona Department of Health Services, and above all – I’m a mom. -
Medicare Advantage enrollment has surpassed traditional Medicare
Medicare Advantage enrollment has surpassed traditional Medicare for the first time in the program's history.
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