Payer

The Medicare Advantage star rating system and its quality bonus payment program is failing to achieve its two main goals of helping beneficiaries select a plan and incentivizing payers to improve plan quality, according to a new report from the…

The most common reason health plans and employers do not pay for pricey weight loss drugs is because they consider these medications to be lifestyle drugs, according to a survey from Pharmaceutical Strategies Group. 

Georgia is implementing work requirements for Medicaid, and other states could follow. 

Molina Healthcare had the largest gains in Medicaid enrollment during the COVID-19 pandemic, according to a report from KFF published July 6. 

"Look-alike" dual eligible Medicare Advantage plans — which primarily enroll people eligible for Medicare and Medicaid but are not regulated as D-SNP plans — grew significantly from 2013 to 2020, a study published in the July issue of Health Affairs…

Many Medicare Advantage plans have narrow networks for psychiatrists when compared to Medicaid managed care and ACA plans, a study published in the July issue of Health Affairs found. 

From Kraft Heinz employees suing Aetna for alleged claims data mismanagement, to the Supreme Court upholding a decision to dismiss a whistleblower lawsuit against a UnitedHealth Group subsidiary, here are seven lawsuits and settlement involving payers Becker's has reported since…

Eli Lilly is now the largest healthcare company in the world by market value, surpassing UnitedHealth Group, Bloomberg reported July 5. 

Ohio Gov. Mike DeWine signed the state's budget, which includes language requiring the state to ask the federal government if it can impose Medicaid work requirements, cleveland.com reported July 6. 

Squabbles over the state's budget could delay implementation of Medicaid expansion in North Carolina.