Here are eight updates on payers since April 15, as reported by Becker’s:
1. The Cigna Group said that it will introduce two new programs to help manage the cost and delivery of GLP-1 drugs.
2. At least eight health systems are scaling back their health plans. Executives have cited rising medical costs, increasing regulatory demands and a desire to focus on clinical operations as reasons for ditching their health plans.
3. UnitedHealth Group and Amedisys have reached a deal to divest some home health and hospice clinics to BrightSpring Health and the Pennant Group.
4. The Department of Justice has filed a sweeping lawsuit against Humana, Aetna and Anthem, along with Medicare Advantage brokers eHealth, GoHealth and SelectQuote, alleging a multi-year scheme involving unlawful kickbacks and discriminatory practices against disabled MA enrollees.
5. Health insurers face “relatively modest short-term effect from tariffs,” according to an April 28 brief from Fitch Ratings. The short-term effects could change though, depending on how long tariffs last and the industries they apply to, and insurers could face higher drug costs if pharmaceutical tariffs occur.
6. CMS is considering proposals that would cut the number of procedures that are subject to prior authorization.
7. The Trump administration boosted payment rates for Medicare Advantage plans. In April, CMS said plans can expect a payment increase of 5.06% in 2026. The increase is higher than the 3.32% plans received in 2024 and the 3.7% they received in 2023.
8. There may be a link between rising insurance premiums and increased utilization of services, particularly across the Medicare Advantage space. In its first-quarter earnings report, UnitedHealth Group reduced its year-end earnings outlook amid rising use of physician and outpatient services among its Medicare Advantage membership and “unanticipated changes in the profile of Optum Health members.”
The post 8 payer updates for ASCs to know appeared first on Becker’s ASC.
