Payer

Payers face multiple industry headwinds, ranging from healthcare worker shortages to the high prevalence of chronic conditions, disjointed member experiences and disengaged members. These headwinds result in gaps in care, unnecessary emergency department (ED) readmissions and other issues.

Forcing states to implement Medicaid work requirements would fail basic constitutionality tests, a group of health policy experts wrote in Health Affairs. 

Pennsylvania Gov. Josh Shapiro signed legislation May 1 that will require all payers operating in the state to eliminate any out-of-pocket costs for annual breast cancer screenings and genetic testing for high risk individuals.

California regulators raised concerns about hiring practices and a surplus of funds at CalOptima Health, a managed care plan with nearly 1 million members. 

Payers are anticipating the cost of expensive new gene therapy drugs to be a significant issue in the coming years, according to a survey from the Pharmaceutical Strategy Group. 

Twenty-six state attorneys general are asking Medicare to cover monoclonal antibody treatments for Alzheimer's disease. 

Georgia Gov. Brian Kemp signed legislation May 2 that establishes a state-managed ACA exchange, pending approval from CMS.

A Montana judge is temporarily halting a rule that would require prior authorizations for Medicaid-paid abortions, the Daily Montanan reported May 1. 

Arbitrators sided with physician services company Envision Healthcare in its dispute with UnitedHealthcare over allegations the payer breached their contract by reducing reimbursement rates. 

Bright Health is moving to sell the last of its Medicare Advantage business, and new enrollments are boosting payers' first-quarter earnings.