Health Payer Specialist

It's not your imagination: as Medicaid rolls have shrunk, people covered by the insurance have been sicker, and now there are numbers to prove it. ow.ly/3C8A50STcRV

In our latest explainer, Health Payer Specialist looks at the contentious, and highly litigious, issue of scoring bids in the government-funded program. Watch on Health Payer Specialist. ow.ly/hTAj50Sa36G

The veteran prosecutor’s former colleagues tell Health Payer Specialist what payers can expect from the new federal task force set up under her leadership: ow.ly/abKq50RNwYU

While there may not be many more stalled contract disputes at this point than last year, a new analysis from FTI Consulting finds both sides are holding out longer and the new strategy is “don’t cave.” ow.ly/U2Lz50RzAZJ

Already dealing with steep losses and a complicated business pivot, Clover Health is now in danger of being delisted from the Nasdaq stock exchange. ow.ly/RwGR50RattR

Hunting for a high-paying job? Bad news: you're likely to have to go into the office. Continue reading at the link below. ow.ly/5r0a50R7tCO

Investors dumped shares of Humana and UnitedHealth Group after the Biden administration stood its ground on proposed Medicare Advantage rates for 2025, disappointing payers that had lobbied to get a boost in the payments. ow.ly/3VuM50R7sGK

Complaints filed with state regulators against UnitedHealth Group jumped 30% last year. Our table shows that about four-fifths of the complaints against UnitedHealth Group are clustered around only three companies within the family. ow.ly/FezF50R5TgM

U.S. Supreme Court seems unlikely to ban the use of mifepristone in abortions, probably avoiding significant disruptions to the operations of payers and pharmacy benefit managers. Read the full article on Health Payer Specialist. ow.ly/fkIc50R3cKS

Molina Healthcare and Commonwealth Care Alliance opted out of Rhode Island's second attempt to bid its Medicaid contract. Continue reading this story on Health Payer Specialist. ow.ly/l6Y150QIM8o

CVS Health executive Prem Shah, who heads the company’s pharmacy and consumer wellness units, has raised over $2 million selling company stock. ow.ly/KyOy50QG8ZS

Star performers are the target for the highest raises and a shift to quality of care and customer satisfaction from financial metrics is in store for health insurance executives this year, human resource specialists say. ow.ly/XTQK50QBkNy

Pacific Steel & Recycling doesn’t hesitate to engage in direct contracting – and push its workers to comparison shop for care. ow.ly/UYch50QAjfh

Cigna is selling its Medicare business to Health Care Service Corp. in a deal that values the division at $3.3 billion. ow.ly/43Kj50QwlNC

Plans sold on exchanges are hitting record enrollment and are also seeing the fastest growth in complaints. ow.ly/n5fH50Qvvsu

Rising medical costs have been in the headlines this month. See these top 10 lists of the health insurers (large, mid-size, and small) whose medical loss ratios climbed the most during the first nine months of 2023. ow.ly/lLw550QvsXA

Two studies released last week highlight the winners and losers in the 2024 Medicare Advantage program. ow.ly/qAl150QtAbS

Humana laid off some workers but is sharing a few details. ow.ly/s0L850QrKvg

More states might be signing up for a new federally funded cost-containment program, and that could turn out to be frustrating for payers. Read more: ow.ly/XLRE50QrLft

From the rising cost of specialty drugs and care to reduced Medicare Advantage bonuses after changes to the star rating system. Here are the major concerns that payers and others identified when we reached out to them. ow.ly/WRo550QqsF1