Payer

On Sept. 25, Georgia Gov. Brian Kemp shared how CMS extended the state’s Pathways to Coverage program through 2026, despite a recent finding from the U.S. Government Accountability Office that the Medicaid work requirement program had spent over twice as…

CMS removed its enrollment sanction on eternalHealth on Sept. 10, according to a news release from the agency. In March, CMS suspended enrollment for eternalHealth’s Medicare Advantage-Prescription Drug Plan contracts after Massachusetts requested the insurer to cease marketing its products…

Counterpart Health, a subsidiary of Clover Health, is leaning more on generative AI to scale value-based care, allowing clinicians to interact with patient data through a chat function, according to a Sept. 25 news release. Counterpart Assistant, an AI-powered physician-enablement…

Oncology care company Thyme Care has raised $97 million in a Series D funding round backed by major insurers Humana and CVS Health, as well as JPMorgan’s Morgan Health division.  The round also drew support from Texas Oncology and Houston-based…

Emerging technology has recently helped health plans share data more efficiently in a variety of ways. Becker’s connected with ten health plan leaders to learn how their organizations have utilized tech for improved data sharing. Like what you see here? Join…

CMS has formally terminated UCare’s Medicare Advantage contracts after the insurer declined to sign agreements for 2026.  The move impacts about 158,000 MA members in Minnesota and western Wisconsin, where UCare is the second-largest MA carrier with 26% market share.…

Twenty-one health insurance companies made the inaugural list of “America’s Best Employers For Company Culture” by Forbes and Statista, a Hamburg, Germany-based data analytics firm, published Sept. 18. Forbes and Statista heard from over 218,000 workers at companies with at…

Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list. Listings were compiled from job-seeker sites.  1. Bon Secours Mercy Health, based in Cincinnati, seeks a director of managed care…

Insurers have until Sept. 30 to issue ACA Medical Loss Ratio rebates for 2024. The Medical Loss Ratio mandates insurance companies spend at least 80% or 85% of their premium dollars on medical care, not administrative expenses or profits. If…

Aging in place, medical care access and economic insecurity are the top three social factors that affect aging experience, according to Alignment Health’s “2025 Social Threats to Aging Well in America Survey.” Over 2,200 adults age 65 or older completed…