Three Medicare Advantage plans scored a full five stars in this year’s health plan rankings from the National Committee for Quality Assurance. An additional 17 plans, including six more Kaiser Foundation Health Plans from around the country, scored 4.5 stars…
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ACA co-op Common Ground Healthcare Cooperative, part of CareSource, is pulling back from offering individual and family health plans in 11 Wisconsin counties in 2026. The change includes all CGHC CareSource plans offered on the exchange and directly from the…
The National Committee for Quality Assurance has named the highest-quality and most-effective health plans of 2025 based on nearly 50 factors that include patient experience and clinical performance. The ratings were released Sept. 16 and draw on 2024 data from…
Aetna’s new “level of severity inpatient payment” policy will take effect in less than two months, and the American Hospital Association said it is “deeply concerned.” Aetna’s policy, set to go into effect Nov. 15, will approve inpatient stays without…
Robert Andrews — a former congressman and the CEO of the Health Transformation Alliance, a cooperative of self-insured companies — predicts AI will be able to personalize formularies for patients within five years. “Formularies are really built upon economic, commercial…
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The California Department of Managed Health Care has issued a cease-and-desist order against Meritage Health Plan, effectively shutting down the Medicare Advantage insurer by the end of October. The Aug. 27 order requires six health plans (Alignment Health, Humana, SCAN…
Employers are gravitating toward “transparent” pharmacy benefit managers this year, according to a survey from the National Alliance of Healthcare Purchaser Coalitions. The 2025 “Pulse of the Purchaser” survey collated responses from purchasers and employers across the country. With nearly…
Seven U.S.-based health payers made Time and Statista’s 2025 list of the world’s top 1,000 companies. Time and market research firm Statista compiled the ranking by evaluating employee satisfaction, revenue growth and sustainability transparency. Cigna ranked 10th overall — jumping…
UnitedHealth Group has boosted lobbying efforts and executives have met with several Trump administration officials this year amid ongoing federal investigations and reimbursement changes that have negatively impacted profits, The Wall Street Journal reported Sept. 14. Since May, UnitedHealth leadership,…
In traditional claim processing, the lack of interoperability between health plan and provider systems often leads to challenges and inefficiencies, like manual data exchange and a lack of transparency. This results in claim denials that drive unnecessary administrative work and…