Payer

Provider groups are joining in payers' concerns about CMS' proposed changes to Medicare Advantage risk adjustments and diagnosis coding. 

From North Carolina legislative leaders agreeing on a plan to a proposal included in Wisconsin's budget, here are three recent updates on state Medicaid expansion efforts: 

Humana CEO Bruce Broussard says proposed Medicare Advantage payment rate changes from CMS will not affect the company's 2024 outlook, Bloomberg reported March 7. 

Blue Cross and Blue Shield of North Carolina reported a net income of $36 million in 2022, for a thin net operating margin of .33 percent. 

The health insurance market outlook is stable in 2023, but earnings growth is expected to slow compared to last year, according to a Feb. 27 report from Moody's.

CareFirst BCBS and Aledade are partnering on new care models by connecting the payer's network physicians with Aledade's tools and resources.

Insurers are urging CMS not to implement proposed risk adjustment changes in Medicare Advantage, but some nonprofit payers say the changes could create a more level playing field for community plans. 

Most of the nation's payers have filed their fourth quarter earnings reports, including insurtechs, or startup health plans with a focus on integrating innovative technologies into their operations.

As the nation prepares to unwind federal policies put in place during the COVID-19 public health emergency, states are gearing up for Medicaid redeterminations this spring.

Highmark Health is partnering with data and analytics platform Kinsa to predict healthcare utilization and staffing needs, and to forecast infectious disease outbreaks.