Medicare, Medicaid and CHIP
Government programs ensure access to healthcare for vulnerable populations. Medicare covers people 65 and older and younger individuals with specific disabilities. Medicaid and the Children's Health Insurance Program (CHIP) are joint federal-state initiatives offering health coverage to low-income families, children, pregnant women, the elderly and people with disabilities.
Top Stories
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News
27 Oct 2025
Do MA Star Ratings incentivize consistent quality performance?
Data shows MA plans move in and out of MA Star Ratings thresholds for lucrative bonus payments, suggesting a potential flaw in the rating system. Continue Reading
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24 Oct 2025
CMS calls back furloughed employees to help with Medicare, ACA enrollment periods
Roughly 3,000 employees are coming back to work on Monday, funded by user fees as the shutdown drags into its fourth week. Continue Reading
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13 Apr 2022
How Health Plans Build Trust to Become Member Advocates
For health plans to become advocates for their members, they must focus on building trust directly with members. Continue Reading
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11 Apr 2022
UnitedHealthcare Expands Maternal Health Equity Program in NC
The payer partnered with an organization that connects members with doulas in order to improve patient education and patient outcomes and advance maternal health equity. Continue Reading
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04 Apr 2022
Aetna Prioritized Member Mental Healthcare, Virtual Care in 2021
Aetna introduced a virtual-first health plan and other virtual offerings, helping to increase member access to affordable medical and mental healthcare. Continue Reading
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01 Apr 2022
How Coverage Mandates May Impact DBT Breast Cancer Screenings
Coverage mandates for a certain kind of breast cancer screening known as DBT may drive utilization upward and cost downward, but the value of this screening remains uncertain. Continue Reading
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31 Mar 2022
Job Satisfaction, Equity Characterize 2022 Wellness Program Design
Overall spending on wellness program design in 2022 is expected to fall, except among large employers who are responding to the shift to hybrid work environments. Continue Reading
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25 Mar 2022
How to Introduce Medicare Advantage Caregiver Benefits in SNPs
Medicare Advantage caregiver benefits should seek to educate members’ caregivers and listen to caregivers’ needs through multimodality. Continue Reading
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23 Mar 2022
High Deductible Health Plans Impact Employee Mental Healthcare
High deductible health plans decreased overall mental healthcare spending, but they also led to a decline in utilization and increased employee mental healthcare spending. Continue Reading
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22 Mar 2022
MedPAC Releases Medicare Advantage Recommendations, BMA Reacts
The commission’s assessment of Medicare Advantage drilled down on how coding intensity might boost Medicare Advantage payments. Continue Reading
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22 Mar 2022
Centene Receives Health Equity Innovation Award from NCQA
Centene’s model pursued health equity by diminishing the care disparity gap in HbA1c testing between the American Indian and Alaska Native populations and White populations. Continue Reading
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21 Mar 2022
How Patient Management Promotes Medication Adherence, Lowers Costs
Comprehensive patient management plans, specifically risk-based care plans, establish relationships between patients and specialty pharmacy nurses to promote adherence. Continue Reading
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17 Mar 2022
UnitedHealthcare Funds Pediatric SCD Behavioral Care, Education
UnitedHealthcare announced it will be funding sickle cell disease behavioral healthcare resources and patient education efforts in Mississippi. Continue Reading
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11 Mar 2022
Medical Debt Points To Holes in Health Insurance Industry
Nine percent of individuals who had been uninsured for zero to six months reported medical debts of $250 or more. Continue Reading
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08 Mar 2022
Payer Orgs Respond to CMS Medicare Advantage Advance Notice
AHIP and ACHP relayed concerns about parts of the Medicare Advantage advance notice like benchmarks and payment methodologies and responded to the health equity index proposal. Continue Reading
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07 Mar 2022
BCBSA Partnership Aims to Increase Access to Low-Cost Insulin
The payer is collaborating on an initiative that will offer members low-cost insulin for no more than $30 per vial and $55 for a box of five pens. Continue Reading
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02 Mar 2022
Employer Sponsored Health Plan Dialysis Costs More Than Medicare
The cost of Medicare-covered dialysis amounted to less than one-sixth the cost of employer-sponsored health plan dialysis. Continue Reading
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01 Mar 2022
Humana Transitions Home Healthcare Products to CenterWell Brand
The payer is fulfilling its promise to begin consolidating certain services for seniors under the new brand, including home healthcare services. Continue Reading
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28 Feb 2022
Commercial Health Plan Trends Reveal High Turnover, Reenrollment Rates
Although most members disenrolled at least once in 12 years, nearly half of commercial health plan members enrolled in their plan again within ten years of disenrolling. Continue Reading
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24 Feb 2022
Employers Identify Key Biosimilar Strategies, Knowledge Gaps
Biosimilars have the potential to reduce healthcare costs, but employers may need to educate themselves and reshape their health plans to accommodate these drugs. Continue Reading
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17 Feb 2022
Humana, UofL Invest in Health Equity, Social Determinants Initiative
Through UofL’s health equity innovation hub, Humana aims to influence health equity and social determinants of health through research, analytics, and community engagement. Continue Reading
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16 Feb 2022
9 Employer Best Practices for High Deductible Health Plan Design
Since high deductible health plans shift more fiscal responsibility to members, employers are learning new ways to empower employees to make the most of their benefits. Continue Reading
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15 Feb 2022
CareFirst Distributes $1.76M to Address Diabetes Epidemic, SDOH
The payer has awarded funds to 27 local health organizations that help address the social determinants of health that may exacerbate the diabetes epidemic. Continue Reading
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15 Feb 2022
7 Steps for Employer Social Determinants of Health Strategies
Employer social determinants of health strategies can range from analyzing existing benefits to assess health equity to providing financial wellbeing classes. Continue Reading
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14 Feb 2022
What Are the Pros and Cons of Consumer Driven Health Plans?
Payers may find that there are both significant advantages and challenges when it comes to consumer-driven health plans. Continue Reading
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09 Feb 2022
AHIP Shares Privacy, Cybersecurity Goals To Protect Consumer Data
Consumer data is becoming increasingly vulnerable as healthcare continues to innovate, but payers, providers, and policymakers can take steps to prevent vulnerabilities. Continue Reading
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07 Feb 2022
BCBSTX Launches SDOH Grant Cycle for Community-Based Organizations
Nonprofit community-based organizations across Texas can apply for the grants and receive funding for their social determinants of health and health equity initiatives. Continue Reading
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04 Feb 2022
3 Major Payer Q4 2021 Earnings Reports Show COVID-19 Impacts
The end of 2021 saw the coronavirus pandemic impact payers fiscally and operationally with renewed energy, according to earnings reports. Continue Reading
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02 Feb 2022
Walmart Launches Provider Recommendation Tool for Health Plan Members
The provider recommendation tool aims to facilitate the process of finding a healthcare provider for Walmart associates who are enrolled in the company’s health plan. Continue Reading
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26 Jan 2022
Change Healthcare May Sell Assets to Prepare for UHG Merger
The payment solution sale could generate more than $1 billion to help Change Healthcare get ready for the upcoming UnitedHealth Group merger. Continue Reading
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25 Jan 2022
Key Factors Behind How Much Commercial Insurers Pay Providers
Hospital market share, input prices, quality of care, and other factors can influence healthcare prices for commercial payers. Continue Reading
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25 Jan 2022
Oscar Health Cost Estimator Tool Aims to Increase Price Transparency
Oscar Health members can use the cost estimator tool to achieve greater price transparency around primary care visits, specialty visits, and other outpatient services. Continue Reading
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18 Jan 2022
How The Affordable Care Act Impacted Small Group Coverage Trends
Small group coverage did not pursue the trends that many experts anticipated after the Affordable Care Act went into effect. Continue Reading
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17 Jan 2022
How Home Health Will Evolve in the Year Ahead
Changes in care delivery and strategic shifts to drive affordable, whole-person care will be important trends in home healthcare in 2022. Continue Reading
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14 Jan 2022
At-Home COVID-19 Tests in Low Supply Before New CMS Requirements
An analysis of six online retailers and ten at-home COVID-19 test brands offered insight into the low supply of at-home COVID-19 tests available and reinforce payers’ concerns. Continue Reading
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13 Jan 2022
Payers Lag On Acupuncture Coverage Despite Rising Utilization
Increased acupuncture utilization has been tied to expanded acupuncture coverage, but most of acupuncture spending is still out-of-pocket. Continue Reading
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13 Jan 2022
UnitedHealthcare Offers Initiatives to Improve Vision, Eye Health
The payer will offer members discounts on laptops and screen filters that help reduce exposure to blue light and support vision and eye health. Continue Reading
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12 Jan 2022
HRSA Expands Preventive Care Coverage Under ACA for Women, Children
The updated preventive care guidelines include coverage of double electric breast pumps without cost-sharing for mothers as well as suicide risk screenings for adolescents. Continue Reading
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10 Jan 2022
Closing Gaps in Care with Advanced Interoperability Capabilities
Payers must improve their ability to access data by addressing interoperability capabilities within their health IT infrastructure. Continue Reading
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07 Jan 2022
Centene Finalizes Acquisition of Behavioral Healthcare Platform
The acquisition of the behavioral healthcare platform will help the payer offer members integrated mental and physical healthcare services. Continue Reading
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06 Jan 2022
Priority Health, Epic Partner to Improve Patient Data Exchange
Priority Health aims to use the payer platform to boost quality of care, lower costs, and to achieve real-time data. Continue Reading
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04 Jan 2022
UHC Will Not Implement Emergency Care Coverage Changes
UnitedHealthcare previously announced that it would change how it assesses emergent care for coverage, but now the payer does not plan to make changes to emergency care coverage. Continue Reading
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04 Jan 2022
Humana Expands Value-Based Care to Medicare Advantage Members in OR
Through a new partnership, Humana Medicare Advantage members will gain access to an integrated care team, physical and mental healthcare services, and regular wellness classes. Continue Reading
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03 Jan 2022
Cancer Patients in High Deductible Health Plans Face Steep Costs
Patients who had cancer faced higher out-of-pocket costs compared to patients who did not have cancer, with patients in high deductible health plans experiencing the most expenses. Continue Reading
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17 Dec 2021
Top 5 Insurers With The Highest Market Shares In The Most States
The payers with the highest national market shares are not the same as the payers with the highest market shares by state. Continue Reading
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16 Dec 2021
Payer Funds Tech, Training To Support Rural Maternity Healthcare
Rural maternity healthcare services are challenging to initiate and maintain, but payers can support growth in these services with their funding. Continue Reading
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14 Dec 2021
MA Plan Introduces Benefits to Address Chronic Disease Management
The new benefits from UVM Health Advantage prioritize chronic disease management, specifically supporting members with heart disease and diabetes. Continue Reading
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13 Dec 2021
2021 Employer-Sponsored Health Plan Spending Growth Hit 6.3%
In 2020, employer-sponsored health plan spending rose by 3.4 percent, but 2021 spending exceeded that, and 2022 is expected to perpetuate the trend. Continue Reading
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08 Dec 2021
BMA Asks CMS to Enhance, Solidify Medicare Advantage Benefits
The letter supported policies that allow health plans to introduce Medicare Advantage benefits that address beneficiaries’ social determinants of health. Continue Reading
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06 Dec 2021
How Health Plans Provide Effective Mental Health Support to Members
Demand for mental healthcare has increased during the pandemic and health plans have an opportunity to streamline access for members. Continue Reading
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03 Dec 2021
Payer Funds Local Practices to Help Address Racial Care Disparities
The $25 million in grants will help local physicians and hospitals improve health equity strategies and address racial care disparities. Continue Reading
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02 Dec 2021
CVS Health Contributes $9.2M to Address SDOH, Homelessness in DC
The payer’s contributions will go toward building a 41-unit housing development in DC that aims to reduce homelessness and increase access to affordable housing. Continue Reading
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02 Dec 2021
UnitedHealthcare Launches Health Plan to Improve Customer Support
The payer has partnered with an accountable care organization to launch the health plan in two Arizona counties, aiming to streamline customer support. Continue Reading
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01 Dec 2021
UnitedHealthcare Vision, Dental Plans Lead in Customer Satisfaction
Vision and dental plan customer satisfaction increased overall in 2021, with UnitedHealthcare receiving the highest scores. Continue Reading
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23 Nov 2021
Humana Expands Medicare Advantage Value-Based Contract in MN
The payer will expand its partnership with Allina Health to cover more members under Medicare Advantage value-based contracts. Continue Reading
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18 Nov 2021
An Overview of 2021 Prescription Drug Benefits: Tiers, Cost-Sharing
There was no singular right way for employers and payers to structure prescription drug benefits in 2021 as the nation continued to struggle with escalating drug prices. Continue Reading
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15 Nov 2021
What Member Engagement Means to Today’s Healthcare Consumers
Health plans have improved their digital member engagement efforts, but they have more opportunities to tailor their activities to improve care management. Continue Reading
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15 Nov 2021
The Status of High Deductible Health Plans with Savings Option
As deductibles continue to grow, large employers are leveraging high deductible health plans with savings option to manage cost-sharing. Continue Reading
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12 Nov 2021
Americans Ready To Choose Coverage During 2022 Open Enrollment
As the coronavirus pandemic continues to influence members’ decision making, Americans are feeling more prepared to select a health plan during 2022 open enrollment. Continue Reading
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11 Nov 2021
Teladoc, Trustmark Announce Virtual-First Health Plan
The partners stated that their virtual-first health plan will centralize around primary care services but would also include mental healthcare and chronic disease management capabilities. Continue Reading
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11 Nov 2021
Humana Announces Changes To Veteran Population Health Management
Humana will add the veteran community to the payer’s Bold Goal initiative in order to improve veteran population health management. Continue Reading
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10 Nov 2021
Payer Third Quarter Earnings Results Spotlight COVID-19 Impact
The impact of coronavirus remained clear across the payer third quarter earnings results for Humana, Anthem, and Aetna. Continue Reading
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09 Nov 2021
Humana Type 2 Diabetes Reversal Program Leverages RPM, Nutrition
Humana’s Type 2 diabetes reversal program will leverage remote patient monitoring and personalized nutrition strategies to improve member outcomes. Continue Reading
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08 Nov 2021
Step Therapy Protocols Vary By Health Plan, 55% Too Strict
Payers use step therapy protocols to lower costs, but some health plans implement step therapy protocols that go beyond clinical guidelines. Continue Reading
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08 Nov 2021
United Behavioral Health Sued for Restrictive Bundled Payment Policy
United Behavioral Health is being sued for allegedly denying claims for medically necessary treatment under its bundled payment policy. Continue Reading
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04 Nov 2021
Coronavirus Pandemic’s Impact on Insurer, Consumer Trends in 2021
Insurers and enrollees shifted behavioral patterns in response to the coronavirus pandemic in 2020 and the repercussions continue to have an impact in 2021. Continue Reading
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03 Nov 2021
COVID-19 May Push Americans To Change Plans For Open Enrollment
Apart from the pandemic, consumers found their own changing healthcare needs and healthcare costs to be compelling reasons for switching plans during open enrollment 2022. Continue Reading
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01 Nov 2021
How Payers Help Tackle Substance Use Disorders, Other Conditions
Payers have several opportunities to improve their coverage options for members who have substance use disorders with co-occurring conditions. Continue Reading
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01 Nov 2021
Aetna Will Offer Some Gene Therapies As Standard Medical Benefit
Aetna established a provider network for gene therapies which will be available to fully-insured and self-insured employers as a standard medical benefit in 2022. Continue Reading
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01 Nov 2021
Leveraging Patient Access APIs to Optimize Risk Adjustment Efforts
The adoption of patient access APIs can enable claims data to move between payers and support improved risk adjustment. Continue Reading
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01 Nov 2021
Addressing Senior Physical, Mental Health With Group Exercise
COVID-19 has taken a toll on seniors’ well-being. The right fitness programs can help lift seniors’ well-being post-pandemic. Continue Reading
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29 Oct 2021
More Employers Turn to Employer-Sponsored Primary Care Clinics
Employer-sponsored primary care clinics can address a variety of employer goals including improving patient access to care, quality of care, and patient satisfaction. Continue Reading
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26 Oct 2021
CVS Health to Offer Coverage for Moderna COVID-19 Booster Shot
Eligible individuals who have received a two-dose mRNA vaccine or a Johnson & Johnson vaccine can receive a Moderna COVID-19 booster shot at select CVS Health pharmacies at no cost. Continue Reading
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25 Oct 2021
Members Find Private Payer Mental Healthcare Networks Inadequate
Even when payers integrate mental healthcare into primary care services, members said that mental healthcare networks paled in comparison to medical care networks. Continue Reading
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25 Oct 2021
Most Payers Are Unfamiliar with Prescription Digital Therapeutics
Prescription digital therapeutics are still young, but payers are starting to consider whether covering these solutions could lower costs. Continue Reading
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25 Oct 2021
Addressing Health Literacy to Improve Member Health, Outcomes
Health literacy is essential to empowering patients to take greater ownership over their healthcare experience and achieve improved outcomes. Continue Reading
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22 Oct 2021
UnitedHealthcare Targets Prenatal Care, Maternal Health Outcomes
UnitedHealthcare will help launch group prenatal care models at OB-GYN clinics in North Carolina to improve maternal health outcomes. Continue Reading
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21 Oct 2021
More Medicare Advantage Plans Offer SDOH Benefits With $0 Premium
In 2022, more beneficiaries will have access to Medicare Advantage plans with $0 premiums that offer supplemental benefits. Continue Reading
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20 Oct 2021
UnitedHealth Group Kicks Off Integrated Virtual-First Health Plan
The new virtual-first health plan will be available in nine cities and will aim to integrate virtual and in-person care needs. Continue Reading
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19 Oct 2021
Financially Burdened Seniors Struggle to Cover Healthcare Costs
In the past year, seniors reported having to delay treatment or postpone other expenses due to high healthcare costs. Continue Reading
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19 Oct 2021
Continuous Marketplace Coverage Led to Increased Prenatal Care Use
Pregnant people who received continuous Marketplace coverage before and during pregnancy were more likely to have high prenatal care use. Continue Reading
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18 Oct 2021
Walmart Increases Self-Funded Employer Access to Cost-Effective Care
Self-funded employer health plans will have access to Walmart’s collection of healthcare services following a partnership between the retail giant and a digital healthcare platform. Continue Reading
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18 Oct 2021
Humana Expands Medicare Advantage Plans, Benefits in Tennessee
Humana intends to introduce new Medicare Advantage plans for Tennesseans in 2022 that address dual-eligible benefits, veteran coverage, and food insecurity. Continue Reading
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18 Oct 2021
A Phased Approach to Next-Generation Member Engagement
A two-phased approach allows health plans to identify and target specific populations and then deploy and measure the effectiveness of their member engagement efforts. Continue Reading
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14 Oct 2021
UnitedHealthcare Shares Growth, COVID-19 Impacts, 2022 Forecast
The third quarter earnings report and call for UnitedHealthcare revealed the impact of the coronavirus pandemic, but ended on a hopeful note for 2022. Continue Reading
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12 Oct 2021
Employer Health Benefits Spending Will Normalize in 2022
After two unpredictable years of healthcare spending, employer health benefits spending will return to prepandemic levels in 2022, employers predicted. Continue Reading
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11 Oct 2021
51% of Employees Satisfied with Employer-Sponsored Health Benefits
Overall, employees reported being satisfied with their employer-sponsored health benefits, but they still expressed the need for more mental health benefits and lower costs. Continue Reading
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07 Oct 2021
Medicare Advantage COVID-19 Hospitalizations Were Lower Than FFS
Medicare Advantage coronavirus hospitalizations and mortality rates were lower than the rates in fee-for-service Medicare during most of 2020. Continue Reading
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04 Oct 2021
How Payers Use Chronic Disease Management Flexibilities in HSAs
The flexibilities for covering chronic disease management in health plans with health savings accounts have enabled payers to reduce cost-sharing for members. Continue Reading
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01 Oct 2021
Blue Cross NC Reduces Lab Service Costs, Unnecessary Testing
Lab service costs can be an expensive category of healthcare spending, but Blue Cross NC aimed to change that with its latest partnership. Continue Reading
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29 Sep 2021
Top 5 Largest Health Insurers in the US by National Market Share
UnitedHealth Group, Anthem, Aetna, and Cigna returned to the list of the top five largest health insurers and one newcomer joined the list. Continue Reading
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29 Sep 2021
Health Insurance Industry Consolidation Grew from 2014 to 2020
At the national level, UnitedHealth Group, Anthem, Aetna, and Cigna maintained their rankings as holding the highest market shares while health insurance industry consolidation grew. Continue Reading
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29 Sep 2021
How Data Aggregation, Sharing Improves Specialty Patient Outcomes
With data supplementation, specialty pharmacies can piece together a complete digital picture of the patient that improves medication adherence and patient outcomes. Continue Reading
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28 Sep 2021
4 Employer Health Benefit Strategies That Lower Healthcare Costs
Advanced primary care, episode-based benefits, integrated health benefits, and association health plans are employer health benefit strategies that can help employers manage costs. Continue Reading
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27 Sep 2021
How Change Management Leads to Successful Member Engagement
Health plans implementing a digital platform for member engagement must consider the importance of effective change management. Continue Reading
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24 Sep 2021
UPMC Partners with Meal Delivery Service, Improves Health Outcomes
The pilot program utilized a meal delivery service that helped members tackle food insecurity and manage chronic conditions. Continue Reading
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20 Sep 2021
How Specialty Pharmacies Connect the Dots for Patient-Centered Care
Specialty pharmacists are able to coordinate services and address social determinants of health, leading to improved medication adherence and health outcomes. Continue Reading
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17 Sep 2021
NCQA Releases Health Plan Performance Ratings with COVID-19 Data
NCQA found that health plan performance for most eligible plans hovered around 3.5 stars overall on measures covering quality of care, patient experience, and health quality processes. Continue Reading
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15 Sep 2021
How Payers Can Cultivate Consumer-Centered Digital Innovation
Consumer-centered digital innovation is increasingly important for payer success, but what digital solutions do members want and how should payers implement them? Continue Reading
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14 Sep 2021
Digital Member Experience Services May Boost Plan Satisfaction
Payers may see increased enrollment and higher member satisfaction levels if they employ omnichannel digital member experience services. Continue Reading
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13 Sep 2021
Payer Extends Medicare Advantage Footprint to Reach 5M Seniors
SCAN Health Plan will offer its senior-first Medicare Advantage Plans in 17 markets across three states starting in 2022. Continue Reading
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13 Sep 2021
6 Reasons to Invest in Next-Generation Member Engagement
Health plans must meet the changing expectations of consumers to deliver a meaningful member experience through targeted member engagement. Continue Reading