When it comes to benefits, employers often look for two things: new ways to keep up with rising healthcare costs and more flexibility in how they offer benefits. To meet these expectations, Providence Health Plan is calibrating its offerings for self-funded employer clients, CEO Don Antonucci told Becker’s. The Portland, Ore.-based health plan is launching […]| Becker's Payer Issues | Payer News
The coming year is expected to be an even more “intense and disruptive” period for Medicare Advantage, as rising utilization, pharmacy costs and shifting market dynamics put new pressure on plans, while also creating opportunities for provider-sponsored models. Becker’s connected with Don Antonucci, CEO of Providence Health Plan, to discuss how the organization is thinking […]| Becker's Payer Issues | Payer News
Mountain Health Co-Op exiting Wyoming | Becker's Payer Issues | Payer News
The Justice Department is urging a federal court to allow a decade-old lawsuit against UnitedHealth Group to continue. In documents filed April 2 in the U.S. District Court for the Central District of California, Justice Department attorneys argued that a court-appointed special master was incorrect in her recommendation to throw out the lawsuit, alleging UnitedHealth […]| Becker's Payer Issues | Payer News
UnitedHealth Group CEO Andrew Witty has stepped down for personal reasons and chairman and former CEO Stephen Hemsley will replace him. Mr. Hemsley served as CEO from 2006 to 2017 and will remain chairman of the company’s board of directors. Mr. Witty will serve as a senior adviser. UnitedHealth has also suspended its 2025 earnings […]| Becker's Payer Issues | Payer News
UnitedHealth Group and Amedisys have reached a proposed final agreement with the Justice Department and attorneys general in four states to resolve an antitrust lawsuit that had temporarily halted their proposed $3.3 billion merger. On Aug. 7, the U.S. District Court for the District of Maryland allowed the $3.3 billion deal to proceed under the […]| Becker's Payer Issues | Payer News
Priority Health, the insurance arm of Grand Rapids, Mich.-based Corewell Health, will become the governing member of Group Health Cooperative of Eau Claire, a Wisconsin-based health plan with more than 61,000 members. Both organizations expect the transaction to close by the end of 2025, pending regulatory approvals. The agreement will make Priority Health a four-state […]| Becker's Payer Issues | Payer News
Optum has acquired Kingsport, Tenn.-based Holston Medical Group, WJHL reported Aug. 11. The 200-provider medical group has more than 70 locations in Northeast Tennessee and Southwest Virginia, according to the report. “Holston Medical Group is pleased to join Optum to support our efforts to continue to provide exceptional health care services to patients in the […]| Becker's Payer Issues | Payer News
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UnitedHealth Group CEO Stephen Hemsley opened the company’s second quarter earnings call on July 29 with a candid message to investors: the organization has made pricing and operational mistakes and is now taking on a “tone of change and reform.” “As we continue to assess the state of our businesses, it is very apparent that […]| Becker's Payer Issues | Payer News
UnitedHealth Group posted a net profit of $3.4 billion in the second quarter of 2025, down from $4.2 billion during the same period last year, according to the company’s July 29 earnings report. The company also set a new 2025 earnings guidance after suspending its outlook on May 13. In December, UnitedHealth projected net earnings […]| Becker's Payer Issues | Payer News
Fitch affirmed UnitedHealth Group’s “AA-” rating July 30 but revised the company’s outlook to negative from stable. Fitch said the revision reflects new information disclosed by UnitedHealth during its second quarter earnings call held July 29. “The company provided guidance on its significantly diminished operating performance for the remainder of 2025, which suggests that it […]| Becker's Payer Issues | Payer News
Geisinger to cut jobs from health insurance division | Becker's Payer Issues | Payer News
Geisinger Health Plan is eliminating nearly 100 positions as part of a restructuring program aimed at stabilizing operations. “This decision, which only impacts GHP roles, was not made lightly,” a spokesperson for the organization told Becker’s on July 15. “We are providing support and resources to impacted employees, and many will be able to move […]| Becker's Payer Issues | Payer News
"Discover the latest workforce reduction efforts and job eliminations in the insurance industry for 2025, including layoffs at major payers like BCBS and Aetna.| Becker's Payer Issues | Payer News
Health plans often prioritize managing high-cost areas like pharmacy, behavioral health, and diabetes while overlooking Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). This oversight results in unmanaged costs, leading to care delays, poor member experiences, and missed opportunities for care coordination.| Becker's Payer Issues | Payer News
Ahead of the health insurance industry’s broader pledge to overhaul prior authorization processes, one Texas payer has already achieved a 7% prior authorization denial rate, with 100% of those denials upheld upon appeal. On June 23, nearly 50 insurers committed to standardizing the electronic prior authorization process, targeting 80% real-time approvals by 2027 and specific […]| Becker's Payer Issues | Payer News
Blue Shield of California is partnering with healthcare booking platform Zocdoc to allow members to schedule in-network, in-person and virtual appointments directly on the health plan’s online portal. The partnership is the first time that Zocdoc has worked with a health plan on member scheduling within an online portal, which is now available to Blue […]| Becker's Payer Issues | Payer News
"Express Scripts, owned by Cigna Group, will implement new policies to protect patients from paying full list price for drugs. Evernorth, Cigna's health service| Becker's Payer Issues | Payer News
Humana's top physician details ambient AI pilot: 5 notes | Becker's Payer Issues | Payer News
Humana is taking proactive steps to address burnout and improve engagement for its thousands of employed or affiliated clinicians by focusing on well-being, reducing turnover, and tackling frustrations related to technology and administrative processes, according to the company’s Chief Medical Officer, Kate Goodrich, MD. Dr. Goodrich discussed the company’s recent ambient AI pilot on the […]| Becker's Payer Issues | Payer News
Cigna is launching a suite of AI tools designed to help members navigate their health benefits. The new features are being rolled out in phases on Cigna’s member portal, according to a June 12 news release. Here are four things to know:| Becker's Payer Issues | Payer News
UnitedHealthcare is the largest insurer in the United States by membership, and Optum is the largest employer of physicians in the country. Here's 50 things to know about healthcare giant UnitedHealth Group.| Becker's Payer Issues | Payer News
UnitedHealth Group is under criminal investigation by the Justice Department for alleged Medicare Advantage fraud, The Wall Street Journal reported May 14. Citing individuals familiar with the matter, the outlet said the DOJ has been investigating the company since at least last summer over its MA business practices, but exact criminal allegations are unclear. UnitedHealth […]| Becker's Payer Issues | Payer News
SCAN Group has purchased full ownership of myPlace Health, an integrated care delivery organization serving older adults in their homes through the PACE model. myPlace launched in 2021 as a collaboration between SCAN and Commonwealth Care Alliance in Los Angeles. SCAN has now fully acquired CCA’s equity interest in the company, according to a May […]| Becker's Payer Issues | Payer News
Payers have faced state penalties in 2025 for slow reimbursements, improper claims denials, and mental health parity violations. Fines in 2024 are here. Payers fined by states in 2025:| Becker's Payer Issues | Payer News
