New York City can implement an Aetna Medicare Advantage plan for its retirees, the state’s highest court ruled June 18. The city has pushed to switch its health benefits for retired city employees to a Medicare Advantage plan since 2021.…
Payer
Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list. Listings were compiled from job-seeker sites. 1. CentraCare, based in Saint Cloud, Minn., seeks a senior director of payer contracting…
How to Build a Technology-First Strategy for UM Effective utilization management (UM) begins with a strategic approach grounded in technology, data, and continuous improvement. As AI adoption accelerates, payers must align their UM strategies with both regulatory demands and operational…
Uncertainty around potential pharmaceutical tariffs is one factor driving up the cost of marketplace coverage in 2025, according to KFF. Multiple insurers, including UnitedHealthcare plans in New York, Maryland and Oregon, and Independent Health have cited tariffs on pharmaceuticals as…
Health system executives are under growing pressure to manage tighter margins, navigate shifting reimbursement models and cultivate strong payer relationships. At the same time, unprecedented volumes of pricing data are becoming available, offering health systems a new source of insight…
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The gap in out-of-pocket spending between Medicare Advantage and fee-for-service beneficiaries is widening, according to a report from the Better Medicare Alliance. The pro-Medicare Advantage group, backed by major insurers, commissioned the analysis, which was conducted by ATI Advisory. The…
Walmart has partnered with Soda Health to launch the Walmart Everyday Health Signals program, aimed at helping Medicare Advantage and Medicaid enrollees make healthier food choices through personalized guidance based on online shopping patterns. Members will receive tailored insights on…
Many insurers are asking for double-digit rate increases in 2026 for the individual and small group exchange markets as they face a potential expiration of enhanced premium tax credits and rising costs.
A federal judge has approved a $69 million agreement to settle a class-action lawsuit that alleged UnitedHealth Group prioritized its business relationship with Wells Fargo over concerns that its 401(k) plan contained low-performing target-date funds, according to court records. Judge…
Fitch Ratings has downgraded the health insurance industry’s outlook to deteriorating from neutral because of rising utilization and Medicaid and ACA cuts proposed in Republicans’ One Big Beautiful Bill Act. The bill was passed by the House of Representatives on…