The Trump administration has boosted payment rates for Medicare Advantage plans, but is also planning what it calls “aggressive” steps to ramp up audits of potential overpayments. Here are seven things to know about the Trump administration’s approach to Medicare…
Payer
Enrollment in Blue Cross Blue Shield plans declined slightly between 2022 and 2024, according to a June 10 report by Mark Farrah Associates, a healthcare industry data aggregator. The report examined differences between BCBS and non-BCBS plan growth between 2020…
CVS Health and a former Express Scripts president have reached a settlement with Cigna over allegations that her departure violated a noncompete agreement. Amy Bricker served as president of Express Scripts — Cigna’s pharmacy benefit manager — before resigning in…
AmeriHealth Caritas reported a net loss of $199 million in 2024, the Philadelphia Inquirer reported June 11. AmeriHealth Caritas serves Medicaid enrollees and is jointly owned by Independence Health Group and Blue Cross Blue Shield of Michigan. The company reported…
Digital tools with a human touch — 4 takeaways on Magellan Health’s partnership with Calm Health
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During a featured session at Becker’s Spring Payer Issues Roundtable in April, leaders from Calm Health and behavioral health provider Magellan Health shared a blueprint for marrying clinical rigor with digital engagement to expand access to behavioral healthcare. Chris Mosunic,…
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The investment arm of Marietta, Ga.-based Wellstar Health System, Catalyst by Wellstar, has invested in Venteur, a digital health startup that administers Individual Coverage Health Reimbursement Arrangement plans. ICHRAs allow employers to contribute tax-free dollars to employees’ health benefits, which…
Moody’s Ratings has downgraded UnitedHealth Group’s outlook from stable to negative, citing “a number of adverse trends simultaneously.” The ratings agency also affirmed the company’s strong credit ratings, including its long-term issuer and senior unsecured debt ratings, as well as…
Coventry Health and Life Insurance Co., an Aetna subsidiary, received an estimated $6.9 million in Medicare Advantage overpayments, an audit published by HHS’ Office of Inspector General June 5 found. The government watchdog reviewed a sample of diagnosis codes Coventry…
Transforming kidney care: A population health approach to improving outcomes and cutting costs
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In a featured session at Becker’s 15th Annual Meeting, Joe Vattamattam, co-founder and president of Healthmap Solutions, presented a data-driven case for value-based kidney care. He emphasized the urgent need for earlier intervention, integrated support, and smarter use of AI…
Seventeen percent of initial Medicare Advantage claims are denied, but 57% of originally denied claims are ultimately overturned, according to a study published June 2 in Health Affairs. The study analyzed 270 million claims from 2019 based on data from…