Health Plan Weekly

Although NeueHealth Inc. — formerly known as Bright Health Group Inc. — still owes a substantial sum of money to health insurers and is struggling to stay afloat, its CEO received a $1.95 million cash bonus last year, according to a new regulatory filing.  

“It really is just a mockery of good governance and fairness at this point,” remarks Ari Gottlieb, principal of A2 Strategies and a prominent critic of Bright and other startup "insurtech" firms.  

NeueHealth did not respond to AIS Health’s questions about the basis for the bonus earned by G. Mike Mikan, who has served as the firm’s president and CEO since April 2020. 

A panel of experts will recommend in a formal report to Congress that ground ambulance-related balance bills should be settled using a rate-setting benchmark rather than arbitration, according to one member of the panel; in addition, the report will recommend that Medicare should begin to cover care that is delivered by ambulance personnel but does not result in a hospital transport. The report is under review by CMS, and is expected to kick off another battle on Capitol Hill over surprise billing policy. 

Balance or surprise billing generally occurs when a person unwittingly receives care from an out-of-network provider and is then billed by that provider for whatever balance remains after insurance reimbursement. According to a member of the panel, the report will recommend that balance bills for ground ambulance care should be banned in virtually all circumstances, including emergency transports to a hospital, interfacility transports and care delivered by EMTs in the field that does not result in a transport to a hospital.  

Trade groups representing health insurers and insurance agents are giving mixed reviews to a recently finalized rule that reinstated strict limits on short-term, limited duration insurance (STLDI) plans. 

The rule, first proposed in July 2023, sought to revive Obama administration-era standards regarding STLDI plans — which are exempt from Affordable Care Act consumer protections such as barring insurers from denying coverage to people with preexisting conditions. Both the Obama and Biden administrations were concerned that consumers often mistake such plans for comprehensive coverage, potentially leaving them with nasty surprises when they need care. 

Data sharing and staff contacts are the keys to improving collaboration between Medicaid managed care organizations and public health departments, according to California officials and plan staffers. Leaders from managed care plans say that close collaboration improves outcomes for high-needs populations who struggle with one or more social barriers to health. 

“When you're looking at claims data, we're obviously not going to see a claim for homelessness. We’re not going to be able to capture that. But when we take our data and bump it against data that's available to some of the public health jurisdictions, and we find out that some of our members are facing housing instability, then that also gives us the ability to understand that maybe their health outcomes are directly being affected by these social determinants of health,” said Nishtha Patel, manager of care transformation at Inland Empire Health Plan (IEHP), during a March 21 Manatt LLP webinar. “No matter what we do intervention-wise, if we're not addressing those, their health outcomes are not ever going to improve.”  

Over the first 10 years of the Affordable Care Act marketplaces, enrollment nationwide has almost tripled, from 8 million individuals in 2014 to 21.4 million in 2024, according to an HHS report.

While the ACA initially envisioned the marketplaces to be developed by states, it also provided states with the option to participate in the federally facilitated marketplace, HealthCare.gov. In 2014, 14 states and the District of Columbia chose to operate their own state-based marketplaces (SBMs). In 2024, there are 19 SBMs.