Payer

Highmark's value-based reimbursement program for primary care physicians, True Performance, has saved more than $3 billion in avoided cost savings in Pennsylvania, Delaware and West Virginia since its launch in 2017.

Medicare Advantage enrollment is growing faster in rural and micropolitan areas than in metropolitan areas, according to an analysis from KFF published Sept. 7. 

Employers that self-fund their employees' insurance pay moderately more for several medical services than fully funded plans, a study published in the September issue of Health Affairs found. 

Humana filed a challenge to CMS' Medicare Advantage clawback rule and said it plans to expand into in-home primary care. 

ACA exchange enrollment reached a record high in early 2023, and the individual market reached an almost record size, according to an analysis from KFF published Sept. 7. 

Most growth in Medicare Advantage enrollment since 2006 was driven by people switching from fee-for-service Medicare to the program, a study by HHS researchers published in the September issue of Health Affairs found. 

From Humana suing HHS over a new Medicare Advantage clawback rule, to Prisma Health accusing UnitedHealthcare of breaching a confidentiality agreement, here are five lawsuits and settlements involving payers Becker's has reported since Aug. 16.  

The number of large employers choosing self-pay over fully-insured benefits has declined since 2010, according to a brief from the Employee Benefits Research Institute published Aug. 24. 

Medicare Advantage plans generally spend less per enrollee than traditional Medicare plans, but these differences vary widely by condition, a study published in the September issue of Health Affairs found. 

Medicare spending per beneficiary has remained stagnant over the past decade, but the reasons why are unclear, The New York Times reported  Sept. 4.