Payer

Enloe Medical Center in Chico, Calif., may no longer be in network with Anthem Blue Cross' managed Medicaid plan if an agreement on reimbursement rates isn't reached, according to the Enterprise-Record.

BlueCross BlueShield of Tennessee and Cigna are issuing rebate checks to Tennessee residents because their healthcare costs were lower than expected, the state's Department of Commerce and Insurance said Sept. 17. 

CMS sent a warning notice to Vermont last week calling for a reboot of its all-payer model, which hasn't met its participation or savings goals, according to the VT Digger.

These nine contract resolutions and dissolutions occurred between payers and providers since early September, beginning with the most recent:

Morristown, N.J.-based Atlantic Health System and Horizon Blue Cross Blue Shield of New Jersey said their shared accountability program is working and has lowered costs by 5 percent in its first year. 

Effective collaboration between payers and providers can be challenging, particularly as more people receive care outside of the hospital and providers shift to reimbursement based on quality of care, rather than volume.

In light of the COVID-19 pandemic, many commercial health insurers waived cost-sharing for medical and behavioral telehealth services.

Group Health Inc., a subsidiary of EmblemHealth, overstated its supplemental executive retirement plan costs to Medicare, according to a report from HHS' Office of Inspector General.

Here are four new partnerships that hospitals and health insurers recently announced:

In 2019, 9.2 percent of Americans, or 29.6 million, didn't have health insurance. That's down from 15.5 percent in 2010, before many provisions of the ACA took effect.