Payer

For payers, the ongoing shift to value-based care has placed a significant emphasis on improving quality and outcomes.

Blue Cross Blue Shield of Arizona is looking to the payer-provider example set by Kaiser Permanente as the Phoenix-based company expands its primary care subsidiary Prosano Health Solutions, the Phoenix Business Journal reported Nov. 20.

UnitedHealth Group outlined its five strategic growth priorities at its annual investor conference Nov. 29: 

UnitedHealth Group expects 2024 revenues to be at least $400 billion. 

About 4.6 million people have signed up for health insurance through ACA marketplaces as of Nov. 18. 

As the nation's largest insurers have evolved to become health services organizations capable of providing healthcare and paying for it too, several Blue Cross Blue Shield companies are following suit and becoming providers as well.

Insurers' outlook is stable for 2023, but high Medicare Advantage utilization rates could present challenges, Moody's said in a Nov. 20 report. 

New research found the number of self-pay patients increased as enrollees lost Medicaid coverage, and Georgia lawmakers are mulling a full expansion of the state's Medicaid program. 

The Medicaid improper payment rate significantly decreased from 2022 to 2023, CMS reported Nov. 15. 

The Hospital Insurance Trust Fund would be solvent until 2048 if traditional Medicare utilization levels were similar to those under Medicare Advantage, according to research published in October by AHIP and conducted by Avalere.