Payer

Replacing the Affordable Care Act has returned as a central healthcare policy issue for Republican presidential candidates following a brief pause from the national spotlight in the 2022 elections.

The Medicare Advantage gold rush is slowing down, Wall Street Journal columnist David Wainer wrote Dec. 5. 

In 2022, 10 states boasted uninsured rates below 5%, and each took specific strategies to get there, according to a Nov. 26 analysis from Vox.

Aetna is a "little bit behind" its peers in value-based care, but it can get ahead by leveraging the rest of the CVS Health business, Aetna President Brian Kane said. 

California's Medicaid program overhaul is improving access to social services, but many health plans, nonprofit community organizations and other stakeholders say reimbursement rates are not covering the full cost of services. 

Here's how the six largest health insurance companies and their pharmacy benefit manager companies stack up. 

States are ramping up scrutiny over how insurers across industries are deploying artificial intelligence for underwriting purposes, Bloomberg reported Nov. 30.

OIG audits found over $213 million in estimated Medicare Advantage overpayments in 2023. 

Approximately 65% of denied claims are not reprocessed for resubmission (Zindl, 2021). Amongst the many challenges facing the healthcare industry, denied claims only continue to rise. Many denied claims are never resubmitted. What does that mean for providers, and what…

Texas has placed Bright Health's subsidiary in the state into receivership and ordered its assets liquidated, according to a court order issued Nov. 29.