Thirty-six percent of providers believe payers reliably deliver on promises, according to an inaugural Aetna provider survey released April 8. The survey will run quarterly, polling representatives of U.S. healthcare providers. This round fielded responses from 827 hospital system executives, physicians, nurses,…
Research & Analysis
From 2012 to 2021, savings across Medicare are estimated to have been $111 billion compared to if Medicare Advantage penetration held at 2011 levels, according to an Elevance Public Policy Institute study published March 23 in INQUIRY: The Journal of…
By 2028, there could be between 4.9 million and 10.1 million fewer people enrolled through Medicaid expansion in an average month as a result of Medicaid work requirements and six-month redeterminations, according to a March 25 research report from the…
ACA insurers denied just under 1 in 5 in-network claims in 2024, similar to 2023, according to a March 24 KFF analysis. Only 3% of the insurers had in-network denial rates of at least 30%, down from 17% of insurers…
At least nine state-run marketplaces have seen a correlation between skyrocketing ACA premiums and enrollees downgrading to bronze plans, according to a March 9 analysis by Healthinsurance.org. The organization is a privately-run website that offers health insurance educational resources for…
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As of February, a share of payers and providers had not yet started working toward the application programming interface requirements established by CMS’ interoperability and prior authorization final rule, according to survey results released March 10 by the Workgroup for…
Continuous glucose monitors have been gaining traction among Medicare Advantage members with Type 2 diabetes, according to a study published in the Journal of Managed Care & Specialty Pharmacy‘s March edition. The Humana Healthcare Research team and Joseph Ross, MD,…
Almost every Medicare Advantage beneficiary in a plan that ended coverage for 2026 had at least one other MA prescription drug plan available this year, according to a March 13 KFF analysis. MA pullbacks, further illustrated by enrollment dips, have…
Medicare premiums may go up as rival insurers acquire pharmacy benefit managers, according to a January study published in the American Economic Journal: Applied Economics. “The PBM has an incentive to potentially disadvantage the rival insurers, which could involve passing…
The demographics and clinical statuses of Medicare Advantage enrollees have been getting more diverse over time, according to research published March 10 in the American Journal of Managed Care. The researchers reviewed enrollment files and pharmacy data spanning 2012 to…