Payer

Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are notoriously costly and complicated conditions to manage.

MediGold, the Medicare Advantage subsidiary of Livonia, Mich.-based Trinity Health, received an estimated $3.7 million in net Medicare Advantage overpayments in 2017 and 2018, according to an audit from HHS' Office of Inspector General published Feb. 16. 

Thirteen states provide doula coverage through their Medicaid programs, and another 12 are in the process of implementing coverage, according to a report from the Elevance Health Public Policy Institute. 

Mississippi lawmakers have introduced a bill that would expand Medicaid for an estimated 250,000 residents, ABC affiliate WAPT reported Feb. 19. 

Nearly 17 million people have been disenrolled from Medicaid since April 2023. 

Medicare Advantage enrollees received less intensive postacute care than their counterparts in traditional Medicare, but did not have a significant change in short-term outcomes, a study published Feb. 16 in JAMA Health Forum found. 

From canceled acquisitions to contract challenges in court, these are five key updates about Blue Cross Blue Shield companies reported by Becker's in 2024:

Technology modernization and the alignment of investments with organizational goals, along with picking the right vendor to partner with, are top of mind for payer executives in 2024, according to a Jan. 30 survey published by digital solutions firm HealthEdge.

It has been a busy few weeks for Medicare Advantage policy. CMS proposed a slight cut in benchmark rates, and payer executives were split on the impact of rising costs in the business. 

Medicaid redeterminations began in April 2023, and all major payers have released their 2023 earnings, revealing which recorded the largest enrollment losses in the Medicaid market.