For all the progress made in shifting the U.S. healthcare system toward value-based care, one of the most powerful levers for improving outcomes and reducing costs remains underused: medications. Medications influence every dimension of health outcomes. They prevent disease progression,…
Payer
The Medicare Advantage (MA) market is entering a potentially transformative phase. Profit pressures, regulatory shifts, and an evolving reimbursement landscape are converging to prompt a strategic reset. A shift from growth-at-any-cost to profitability-first Like many publicly traded payors with significant…
The federal government has shut down for the first time since 2019 after lawmakers failed to reach a funding deal, with the fate of enhanced ACA subsidies, set to expire at year’s end, hanging in the balance. Premium tax credits…
The ACA marketplace’s open enrollment period kicks off on Nov. 1, but HealthCare.gov and states have price previews already available. The shopping window will remain open until Jan. 15, 2026, but those assessing their coverage face uncertainty. The fate of…
Minnesota Gov. Tim Walz has paused payments for 14 high-risk Medicaid services for up to 90 days while a third-party audit is conducted. The state’s Department of Human Services has contracted with Optum, which will analyze Medicaid fee-for-service claims data…
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UnitedHealth Group is projecting its Medicare Advantage enrollment will decrease by 1 million people in 2026. That estimate is up from a 600,000-member decrease it projected in July. UnitedHealthcare CEO Tim Noel said on the company’s Oct. 28 earnings call…
Optum Health, UnitedHealth’s care services division, “strayed from the initial intent,” said Optum CEO Patrick Conway while discussing the unit’s performance during UnitedHealth Group’s Oct. 28 earnings call. However, he remained confident that the company can push the business forward. Mr.…
Humana’s board of directors declared a $0.885 per share dividend to be paid on Jan. 30, 2026. The dividend will be paid to all shareholders of record as of the close of business Dec. 26, according to an Oct. 28…
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. Broward Health, based in Fort Lauderdale, Fla., seeks a manager of managed care…
Improving member experience remains a top priority for payers — and for Medicare Advantage plans, it’s not just a goal but a business imperative. Member experience directly influences CMS Star Ratings, which in turn affect financial performance. At the heart…