Payer

Executive Summary: Health plans must ensure network adequacy to meet regulatory requirements, maintain consumer trust, and provide a fulfilling member experience. However, network adequacy remains a fundamental challenge for plans due to inaccuracies in provider data. Health plans struggle with…

Highmark Western and Northeastern New York reported a net loss of $140 million in 2024, Buffalo Business First reported Feb. 28.

UnitedHealth Group has more than 2.8 million enrollees in special needs Medicare Advantage plans in 2025, according to CMS data published Feb. 25. 

Maryland has sanctioned Medicaid managed care organization Priority Partners following the suspension of its health plan accreditation by the NCQA.

For health plans, the numbers are sobering: rising medical loss ratios, escalating healthcare costs, and increasingly complex patient needs are straining resources across the industry. Yet within this challenging landscape lies an overlooked opportunity for transformation: medication optimization.

Blue Cross Blue Shield of Massachusetts reported a $400 million operating loss in 2024, driven by spending on GLP-1 medications and other rising medical costs. 

Elevance Health and Centene saw their Medicaid memberships decline by more than 20% through the redeterminations process. 

The New Hampshire Insurance Department has issued an order requiring Aetna to prove why it should not be fined or have its operating license suspended in the state. 

Blue Cross Blue Shield of Michigan had more than 750,000 members across its Medicare Advantage plans in 2025, according to CMS data published Feb. 25. 

Here are 10 updates on UnitedHealth Group and its subsidiaries that Becker's has reported on since Feb. 6: