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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13 Nov 2024
Understanding Medicare vs. Medicaid vs. CHIP
Medicare, Medicaid and CHIP are very influential in the healthcare industry at large, often steering trends in value-based care, social determinants of health and health equity. Continue Reading
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17 Oct 2024
Medicare Advantage growth persists ahead of open enrollment
Medicare Advantage growth continues, spurred on by high quality of care, lower costs and better access to care. Continue Reading
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09 Jun 2021
Care Deferrals, Digital Tools Will Shape 2022 Medical Cost Trend
The coronavirus pandemic is expected to continue exerting pressure on healthcare spending in 2022, with experts projecting a medical cost trend of 6.5 percent. Continue Reading
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08 Jun 2021
Largest Share of Premium Dollar Goes Toward Prescription Drugs
AHIP’s updated report details how commercial payers spend member premium dollars and which services receive the most premium income. Continue Reading
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07 Jun 2021
UHC Changes Emergency Department Claims Evaluation Protocols
Starting in July, the payer will provide coverage for emergency department claims only if they are deemed to be emergent, in an attempt to cut back on healthcare spending. Continue Reading
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07 Jun 2021
BCBSOK, OUHP Settle Dispute, Work Toward Long-Term Contract
The payer and provider have settled their dispute, enabling OU Health Physicians to remain in-network, despite past disagreements. Continue Reading
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03 Jun 2021
Humana Expands Value-Based Care Model to Cover More Seniors
A Humana senior care provider is working to improve health outcomes and reduce costs for Medicare members by expanding its value-based care model. Continue Reading
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03 Jun 2021
Payer Partners with Nonprofit to Improve Prenatal Care Access
UnitedHealth Group and CAMBA are working together to improve maternal and infant health outcomes and increase prenatal care access for underserved women in Brooklyn. Continue Reading
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01 Jun 2021
Commercial Plan Member Satisfaction Jumps 10 Percentage Points
The survey named 21 health plans that scored the highest on member satisfaction, which covered factors such as billing and payment, cost, and provider choice. Continue Reading
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28 May 2021
Health System Joins Blue Cross NC to Expand Value-Based Care
Blue Cross NC and Mission Health have partnered together to expand value-based care and increase healthcare services for Medicaid members. Continue Reading
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27 May 2021
UPMC Health Plan Virtual Assistant Aims to Improve Access to Care
The voice-activated virtual tool, available with Alexa and Google Assistant, was designed to help UPMC Health Plan members find information about benefits and access to care. Continue Reading
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25 May 2021
Medicare Advantage Dual Eligibles Have Better Access to Care
Medicare Advantage dual eligibles are more likely to have risk factors than their traditional Medicare counterparts, but they had better access to care and to telehealth in 2020. Continue Reading
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25 May 2021
Trends Emerge Among Payers on Affordable Care Act Marketplace
As the Affordable Care Act marketplace stabilizes, Medicaid managed care and Blue Cross Blue Shield companies continue to compete for market share. Continue Reading
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24 May 2021
MA Plan Announces Program to Improve Senior Mental Healthcare
In response to heightened loneliness due to social isolation during the pandemic, a Medicare Advantage plan has launched a program to improve seniors’ mental healthcare. Continue Reading
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24 May 2021
How Healthcare Workflows Can Use Intelligent Automation for Better Care
Intelligent automation will enable payers to ensure high-quality care for members and improved member experience. Continue Reading
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21 May 2021
JPMorgan Chase Reveals Employer-Sponsored Health Plan Goals
Morgan Health, the financial services firm’s new healthcare business unit, seeks to become a model for employer-sponsored health plans. Continue Reading
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20 May 2021
Medicare Advantage Plans Draw More Members with Chronic Diseases
Medicare Advantage plans saw a higher number of members with chronic diseases, substance abuse, and serious mental health conditions. Continue Reading
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19 May 2021
Bold Goal Saw Better Medicare Advantage Health Outcomes in 2020
The Humana Bold Goal program, which started in 2015, aims to diminish social determinants of health barriers and improve Medicare Advantage health outcomes in 16 cities. Continue Reading
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18 May 2021
Cigna Funds Education, Workforce to Improve Social Determinants
The Cigna Foundation has launched a grant program for nonprofits that work to improve access to education, sustain the healthcare workforce, and overcome social determinants of health barriers. Continue Reading
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17 May 2021
4 Ways ADT Event Notifications Improve Payer Performance
Admission, discharge, and transfer (ADT) notifications allow payers to better manage member health and healthcare spending Continue Reading
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17 May 2021
Endpoint Directory Supports Payer Interoperability Compliance
Payer interoperability compliance is challenging even with the extended timeline, but a newly released endpoint directory aims to enable necessary payer-vendor connections. Continue Reading
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17 May 2021
How the Healthcare Industry Can Close Gaps in Care Caused by COVID-19
The pandemic created numerous gaps in care, but effective member engagement that can close them efficiently and effectively. Continue Reading
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12 May 2021
CVS Health Responds to Caregivers' Pandemic Mental Health Needs
CVS Health and Aetna are shining a light on mental health resources to help women and caregivers manage their heightened stress resulting from the coronavirus pandemic. Continue Reading
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12 May 2021
Blue Shield Aims to Reduce Mental Health Racial Care Disparities
The health plan aims to reduce racial care disparities in California communities of color by providing funds to local youth organizations. Continue Reading
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11 May 2021
How to Consolidate Member Experience Data to Boost Satisfaction
By drawing member experience data from across various departments and throughout the member journey of care, payers can improve health plan satisfaction. Continue Reading
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10 May 2021
Payer Launches Discharge Program To Lower MA Hospital Readmissions
Retirees with Medicare Advantage coverage will be eligible for a home discharge support program that is expected to lower hospital readmissions. Continue Reading
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06 May 2021
AHIP: Private Payers Boost Insurance Coverage, State Economies
Private payers contribute to the local economy through taxes and job opportunities while creating insurance coverage for over 60 percent of the population in 15 states. Continue Reading
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06 May 2021
Despite More Symptoms, COVID-Era Mental Healthcare Claims Decrease
Mental healthcare claims have decreased during the COVID-19 pandemic even though more adults have reported symptoms of anxiety and depression. Continue Reading
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05 May 2021
CVS Tackles Care Disparities, Community-Based Preventive Care
The community-based program is expected to address care disparities by providing free or low-cost preventive care services in at-risk communities. Continue Reading
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03 May 2021
Data Science & Healthcare: Why Health Plans Must Do Better with Data
Data science and predictive analytics enable health plans to provide effective care management based on an understanding of health risks. Continue Reading
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30 Apr 2021
Payers Address COVID-19 Vaccine Uptake With Member Engagement
As the country hits a COVID-19 “vaccine wall,” health payers are encouraging uptake through community partnerships and targeted member outreach. Continue Reading
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29 Apr 2021
UnitedHealthcare Boosts Integrated Care Benefit Program To Up Value
Enhancements to UnitedHealthcare’s integrated care benefit program are expected to streamline the member experience and promote value-based care. Continue Reading
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28 Apr 2021
Humana Continues Home Healthcare Expansion in $8.1B Acquisition
Humana will complete its acquisition of Kindred at Home, in which it has held a minority stake since 2018, to advance the payer’s home healthcare expansion. Continue Reading
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27 Apr 2021
Employer Costs Could Drop 43% with Younger Medicare Eligibility
Adjusting Medicare eligibility age threshold could have major impacts on employers’ healthcare spending. Continue Reading
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26 Apr 2021
Cigna Includes Employees in Coronavirus Vaccine Uptake Efforts
The payer expanded coronavirus vaccine uptake incentives not only to its members, but also to its employees. Continue Reading
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22 Apr 2021
Agent Tools Offer Information on 43% of Medicare Advantage Plans
Agents are not financially incentivized to offer information on Part D and Medicare Advantage plans that are not in their contracts, hindering beneficiaries from making an informed decision. Continue Reading
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22 Apr 2021
Health Equity Effort Engages Community Partners, Progress Measures
BCBSA is tackling racial health disparities with a health equity strategy centered around community partnerships and progress measures. Continue Reading
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21 Apr 2021
UnitedHealth Q1 Care Activity Under Baseline, Revenue Growth Persists
UnitedHealth Group’s Q1 2021 revenues increased 9 percent and operations earnings grew 35 percent when compared to the first quarter of 2020. Continue Reading
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21 Apr 2021
CVS, Aetna Care Coordination Plan May Cut Out-Of-Pocket Costs
A new health plan provides care coordination to lower out-of-pocket costs, while also increasing access to care, for members in Southern California. Continue Reading
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20 Apr 2021
Payer Community Health Partnerships to Address Food Insecurity
More than 2,000 Blue Cross NC members are enrolled in prevention programs that address social determinants of health such as food insecurity. Continue Reading
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19 Apr 2021
Addressing Social Determinants of Health Through Improved Digital Engagement
Social determinants of health play an important role in effective digital engagement by payers. Continue Reading
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19 Apr 2021
Health Plan Differentiation: The Big Disruptor in Senior Fitness
Health plan differentiation is key to improving member satisfaction and health outcomes, especially for Medicare Advantage. Continue Reading
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14 Apr 2021
Payer, Provider Launch Wellness-Focused Medicare Advantage Plan
The partners will be focusing on wellness as much as they focus on illness and emphasized that the health plan will be provider-led. Continue Reading
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12 Apr 2021
Identifying New Opportunities for Innovation in Supplemental Benefits
Supplemental benefits will play a vital role in future benefit design to deliver benefits that members are expecting and demanding. Continue Reading
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09 Apr 2021
Cigna + Oscar Extend Small Business Health Plan Footprint
The Cigna + Oscar brand’s small business health plan will be available to employers in California as businesses flounder due to the coronavirus pandemic. Continue Reading
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08 Apr 2021
Docs Say Payers Restored Prior Authorization in COVID Second Wave
Physicians reported that prior authorization programs delayed necessary care access and lead to poor patient outcomes during COVID-19’s peak. Continue Reading
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06 Apr 2021
Wellness Programs Are A Win-Win For Cost Saving, Member Outcomes
A payer received a two-fold return on investment after implementing a wellness program that significantly improved outcomes for members with obesity. Continue Reading
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05 Apr 2021
UnitedHealthcare Medicare Advantage Dominates MA Enrollment 2021
While the Medicare Advantage space saw a burst in overall enrollment in 2021, for-profit plans—particularly UnitedHealthcare Medicare Advantage plans—drove that increase. Continue Reading
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05 Apr 2021
How COVID-19 Proved the Value of Supplemental Benefits
The public health crisis has emphasized the ability of supplemental benefits to make access to affordable essentials a reality for vulnerable populations. Continue Reading
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02 Apr 2021
Payer Provides Homebound COVID-19 Vaccine Access, Best Practices
Massachusetts has called on a payer to enlist best practices in the statewide effort to provide COVID-19 vaccine access to the homebound population. Continue Reading
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01 Apr 2021
Payers Fund Community Health Centers to Aid Population Health
Payers are seizing opportunities to fund community health centers in order to support population health management. Continue Reading
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01 Apr 2021
Health Orgs Support MA Risk Adjustment For Audio-Only Telehealth
Several healthcare organizations have united in their call for audio-only telehealth strategies to count towards Medicare Advantage risk adjustment. Continue Reading
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31 Mar 2021
How Payers Are Involved in Boosting COVID-19 Vaccine Confidence
Payers are targeting coronavirus vaccine confidence through collaborations, marketing tools, and incentive programs. Continue Reading
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30 Mar 2021
Medicare Advantage Cost Burden Is Lower Than in FFS Medicare
For low-income beneficiaries, the Medicare Advantage cost burden proved to be nearly half as prevalent as the cost burden for traditional Medicare beneficiaries. Continue Reading
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29 Mar 2021
Payers Partner with Lyft to Expand Coronavirus Vaccine Access
The two payers are partnering with local health centers and nonprofits in order to coordinate ridesharing to expand coronavirus vaccine access. Continue Reading
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29 Mar 2021
Humana, Epic Tackle Electronic Prior Authorizations, Member Data
The payer and vendor are shifting their focus to implementing an electronic prior authorization solution to reduce delays in care delivery. Continue Reading
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29 Mar 2021
Why User-Centered Design Is Crucial to Member Engagement
Member-facing tools based on user-centered design are key to effective engagement during and beyond the pandemic. Continue Reading
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26 Mar 2021
Anthem Plans to Acquire myNEXUS, Expand Home Healthcare Services
Anthem’s move echoes the payer industry’s focus on improving access to and quality of home healthcare services for seniors. Continue Reading
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25 Mar 2021
Electronic Prior Authorizations Impact Quality, Provider Burden
In order to soothe the controversies around prior authorizations, payers and providers may turn to electronic prior authorizations for faster care delivery and lower burden for providers. Continue Reading
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24 Mar 2021
How Payers Can Prepare for the Payer Price Transparency Rule
The fate of the payer price transparency rule has yet to be determined, but payers should begin preparations for compliance nonetheless. Continue Reading
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23 Mar 2021
Shared Financial Risk of Dialysis May Lead to Medicare Cost Saving
Adults on dialysis with employer-sponsored plans who switched to Medicare prematurely cost CMS $3 billion, signaling the need for shared risk. Continue Reading
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22 Mar 2021
13 Areas of Low-Value Care Spending in Medicare Advantage Plans
Although the Medicare Advantage model is frequently touted as an example for pursuing value-based care, there are multiple areas in which these plans support low-value care spending. Continue Reading
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22 Mar 2021
Achieving Holistic Care Through Effective Digital Health
Effective digital health views a person's health as much more than a doctor’s visit. Continue Reading
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19 Mar 2021
Payer Announces Virtual Care Option for Hearing Care Access
To provide greater hearing care access to members and lower out-of-pocket costs, UnitedHealthcare Hearing has introduced a virtual care capability. Continue Reading
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18 Mar 2021
Blue Cross NC Initiates Medicaid Managed Care Enrollment Period
The Medicaid managed care plan will provide beneficiaries with access to a broad provider network and social determinants of health support. Continue Reading
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17 Mar 2021
Employer-Sponsored Health Plans See Strong Member Satisfaction
Despite the coronavirus pandemic’s blow to employer-sponsored health plans, members appreciated their health plans' care coordination and prescription drug refills. Continue Reading
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16 Mar 2021
Humana Will Begin Transitioning Senior Services Into New Brand
The payer’s new brand, CenterWell, will incorporate multiple payer-agnostic services, but Humana will start by phasing-in its senior services. Continue Reading
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15 Mar 2021
Payer Eyes Health Equity With COVID-19 Vaccine Access Network
Blue Shield of California has expanded its network to cover over 1,200 COVID-19 vaccination sites, boosting vaccine access for at-risk populations. Continue Reading
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15 Mar 2021
How OTC Medicines, Supplemental Benefits Improve Care, Cost
Over-the-counter (OTC) medicines play an essential role in keeping individuals and populations healthy while, at the same, time driving down healthcare spending. Continue Reading
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12 Mar 2021
Creating Strategies to Expand Transgender Healthcare Coverage
Data collection and stakeholder communication are key, but ultimately transgender healthcare coverage is a matter of listening and acting. Continue Reading
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11 Mar 2021
NCQA Calls for Digital Quality Measures in Value-Based Care Plans
CMS should employ the use of a digital quality measure system to ensure consistent, efficient quality reporting within value-based care plans. Continue Reading
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11 Mar 2021
BCBSMA Invests in Electronic Registry for End-Of-Life Care Quality
A BCBS investment will fund the development of a Massachusetts statewide electronic registry to ensure providers deliver quality end-of-life care. Continue Reading
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10 Mar 2021
An Overview of Disruptive Payers That Filed for an IPO in 2021
Both Oscar Health and Alignment Healthcare have been disruptive payers in the health insurance world for their use of technology. Continue Reading
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09 Mar 2021
How Payers Can Take Action Against Racial Care Disparities
Racial care disparities occur throughout the healthcare system, but payers have a unique opportunity to effect change. Continue Reading
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08 Mar 2021
Rural Medicare Advantage Members Hit Care Access Snags, Switch Plans
About 10% of rural members enrolled in Medicare Advantage plans reported care access dissatisfaction in comparison to just 4.6% of nonrural beneficiaries. Continue Reading
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08 Mar 2021
Improving Member Experience with a Unified Data Platform
Data and department silos are preventing actionable intelligence into the right hands to achieve quality improvement. Continue Reading
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04 Mar 2021
AHIP, BCBSA Pilot Supports Equitable COVID-19 Vaccine Delivery
The payer organizations will enable equitable COVID-19 vaccine delivery by targeting the two million most vulnerable seniors in the US and leaning on various partnerships. Continue Reading
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02 Mar 2021
Payer Partners with CBOs to Reduce Maternal Care Disparities
BCBSIL’s approach underscores the critical role that payer partnerships with community-based organizations can play in reducing maternal care disparities. Continue Reading
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01 Mar 2021
Three Common Characteristics Among Virtual-First Health Plans
Although payers are still exploring how to best use virtual care and telehealth technologies, virtual-first health plans have started to develop a couple of consistencies. Continue Reading
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26 Feb 2021
Lower Spending Drives Senior Satisfaction with Medigap Policies
Although seniors still have concerns around affordability related to their Medigap policies, they appreciate lower out-of-pocket costs on hospital and physician services. Continue Reading
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22 Feb 2021
Top 5 Common Conditions Driving Employer Healthcare Spending
Five common conditions, most of which are chronic, fuel employer healthcare spending and can—by extension—impact payer’s spending. Continue Reading
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22 Feb 2021
Adopting a Member-Centered Approach to Digital Health Management
Payers have a real opportunity to play a meaningful role in the future of healthcare as an advocate for patients. Continue Reading
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19 Feb 2021
Humana Announces MA Chronic Disease Management, SDOH Model
Through this model, Humana seeks to improve chronic disease management for seniors with complex conditions and the payer plans to expand the program in 2021. Continue Reading
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18 Feb 2021
Payer Seeks to Lower Behavioral Health Hospital Readmissions
The payer’s new program seeks to reduce behavioral health hospital readmissions by five percent through counseling, medication management support, and case management. Continue Reading
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17 Feb 2021
Aetna to Re-Enter ACA Individual Health Insurance Marketplace
The payer has yet to finalize which markets it will join, but executives committed to re-enter the individual health insurance marketplace on January 1, 2022. Continue Reading
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16 Feb 2021
Humana, IBM Partner To Streamline Member Engagement With AI
The payer and technology company will focus on improving and personalizing member engagement, particularly engagement related to healthcare spending and benefits information. Continue Reading
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15 Feb 2021
Payer Extends COVID-19 Treatment, Telehealth Benefits Through 2021
Blue Cross and Blue Shield of Minnesota has extended COVID-19 treatment and telehealth benefits past the HHS’ public health emergency period. Continue Reading
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12 Feb 2021
How Payer Forecasting Is Shifting Towards Real-Time Data Analytics
A real-time data analytics approach demands that payers pursue full interoperability and requires a different mindset than the traditional approach has required. Continue Reading
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11 Feb 2021
Payer Aids Federally Qualified Health Centers in COVID-19 Efforts
By funneling funding towards federally qualified health centers, the payer supports local vaccination, outreach, and access to care efforts. Continue Reading
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10 Feb 2021
Payers Expect Enrollment to Offset Normalized Healthcare Spending
Payers anticipate that increased membership, lower utilization, potentially a higher federal medical assistance percentage, and other factors could offset healthcare spending as it returns to normal levels. Continue Reading
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09 Feb 2021
Payers Prepare For Costs in 2021 After COVID-19 Deferred Care
After COVID-19 drastically cut costs, payers are preparing for the coming benefit year’s costs to account for a year’s worth of deferred care. Continue Reading
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08 Feb 2021
More MA Plans Offering Benefits for Members with Chronic Diseases
More Medicare Advantage members with chronic diseases have access to food-related benefits from their health plan in 2021 than in 2020. Continue Reading
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04 Feb 2021
BCBS Introduces Value-Based, Patient-Centered Kidney Care Model
Blue Cross NC has launched a value-based care model set to improve health outcomes and member experience using patient-centered kidney care. Continue Reading
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02 Feb 2021
Consolidated Medicare Advantage Plans See Quality Improvement
Payers that consolidate Medicare Advantage plans with lower star ratings into plans with higher star ratings deliver higher quality of care for enrollees who were previously in low-rated plans. Continue Reading
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01 Feb 2021
Aetna Updates Policies to Cover Transgender Feminizing Surgeries
The payer updated its policies in response to four transgender members who came forward and demanded better access to care after their feminizing surgery claims were denied. Continue Reading
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29 Jan 2021
Experts Call For Updated Medicare Advantage Star Ratings Survey
The Medicare Advantage consumer survey requires modernization to accurately gauge member experience and promote value-based care. Continue Reading
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28 Jan 2021
Anthem Earnings Call Projects COVID-19 Vaccine Impact, ACA Growth
Anthem executives plan to focus on modernization in 2021, with an emphasis on artificial intelligence, automation, and telehealth. Continue Reading
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28 Jan 2021
Patient Navigators Call For Funding To Promote Marketplace Care Access
After marketplace cuts under the Trump administration, patient navigators are asking for funding to promote care access during a COVID-19 enrollment period. Continue Reading
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27 Jan 2021
Medicaid Expansion Helped Detect Undiagnosed HIV Infections
Improved care access led to increased detection of undiagnosed HIV infections and use of HIV prevention services in Medicaid expansion states. Continue Reading
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25 Jan 2021
How Top Payers Are Providing COVID-19 Vaccine Coverage, Support
While certain rules govern coronavirus vaccine coverage during the public health emergency, some payers are looking beyond the crisis. Continue Reading
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25 Jan 2021
Health Payer Unveils Virtual Care Plan, Telehealth Care Access
The first virtual care plan on the Texas Exchange utilizes telehealth technology to promote care access to primary and preventative services. Continue Reading
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22 Jan 2021
2021 Payer Strategies Build on Telehealth, Gene Therapy Lessons
Payers will hone their telehealth and gene therapy strategies in 2021 and will also refine their forecasting capabilities. Continue Reading