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There will be at least six new carriers on ACA marketplaces in 2027, despite the continued pressures facing the wider…
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As insurers pivot their market and product strategies, executive leadership has been evolving at health plans and their parent companies. Here are 30 payer leadership moves to know from the second half of 2026:
Humana has pulled off a Medicare Advantage star ratings turnaround, with 95% of the insurer’s members in plans rated four stars or higher for 2027, compared to 20% a year ago. “I’m grateful for what our team accomplished this year,…
Medicaid members with behavioral health conditions pass through emergency departments, inpatient units and outpatient follow-up as though each were a separate system. For most plans it is, and the members who need coordination most are the least likely to get…
Presented by:
- Kristi Carney, Director of Behavioral Health, CareSource, Indiana Market
- Nishi Rawat, MD, Chief Clinical Officer and GM Care Navigation, Bamboo Health
Fifteen Medicare Advantage plans earned five-star ratings for 2027, down from 22 last year. CMS released the ratings Oct. 8. Of the 508 contracts that were rated, 188 (37%) earned four stars or higher, compared with about 44% in 2026. About…
CMS estimates that 77% of fiscal year 2025 Medicaid improper payments resulted from insufficient documentation rather than fraud or abuse, according to an Oct. 7 report from the Congressional Research Service. The report outlines how federal and state agencies oversee…
In a new lawsuit, Michigan Attorney General Dana Nessel is accusing Blue Cross Blue Shield of Michigan of conspiring with other Blues plans to block competition and using its grip on the health insurance market to overcharge the state and…
Dispute activity under the No Surprises Act continues to evolve, court decisions are influencing the regulatory landscape, and the Final Rule could change how health plans and healthcare organizations approach key requirements. This session offers a data-driven look at where…
Presented by:
- Jennifer Forcash, Assistant Vice President Surprise Bill Solutions, Claritev
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. Advocate Health, based in Charlotte, N.C., seeks an area vice president of managed…
Humana and the University of Louisville reported Oct. 6 that the company contributed nearly $20 billion to the state’s revenues and output in 2025. This includes estimates of roughly $6.4 billion in direct impact, $9 billion in indirect impact and…
A Florida appellate court ruled Oct. 7 to expunge a grand jury report regarding a $10 million Centene donation to the Hope Florida Foundation, tied to Florida’s first lady, Casey DeSantis. Florida prosecutors launched a criminal investigation into the donation,…
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Beyond the Test: Preparing Health Systems for the Next Era of Cancer Monitoring
Presenter: Rick Baehner, MD, University of California, San Francisco
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