Payer

Lawmakers in South Dakota rejected a Republican-led effort to expand the state's Medicaid program via a state statute, now leaving it to voters to approve the move, according to the Argus Leader. 

Grand Rapids, Mich.-based payer Priority Health told members Feb. 14 that an unauthorized user accessed private information through its Priority Health Member Portal. 

Profits were down year over year for half of the country's largest payers in 2021, but didn't stop double-digit growth for others. 

Six payers dominate the health insurance landscape in the United States, but each has taken dramatically different paths that define their approaches to the industry today. 

Payers, including Blue Shield of California, have been strong-armed to contract with the entire Sutter Health hospital system instead of being able to pick specific facilities to bring into their networks, according to Law360. 

California is reforming its Medicaid program, Medi-Cal, to address social determinants of health — a move that shifts state-sponsored health coverage toward whole-person health, according to CalMatters. 

Excellus BlueCross BlueShield is distributing $30 million across 31 New York providers to invest in quality improvements, according to a news release shared with Becker's. 

Payers' medical benefits ratios — the percentage of premium revenue spent on medical services — have fluctuated with the flow of the COVID-19 pandemic, resulting in industrywide increases.

Payers have been calling the Medicare Advantage market a competitive, but highly-desirable one. 

Mothers have increasingly opted to give birth in their homes during the COVID-19 pandemic, but insurers are largely refusing to cover them, according to a Feb. 11 report from Time.