Health Plan Weekly

As the number of No Surprises Act (NSA) payment disputes being sent to arbitration continues to climb, health care providers are winning disputes more often than health plans and earning higher payouts, according to a new analysis.

“Clearly, it is an added cost for plans,” says Jack Hoadley, research professor emeritus at Georgetown University's Health Policy Institute and coauthor of the analysis. He observes that those costs come in various forms: the fees associated with Independent Dispute Resolution (IDR) cases, the staff time needed to address the cases filed against insurers, and claims costs when insurers lose cases.

Furthering its mission of addressing the leading health care issues facing older adults, SCAN Group recently assumed full ownership of myPlace Health, which operates a Program of All-Inclusive Care for the Elderly that serves Medicaid-only and dual-eligible adults who are living independent in the community but can receive medical care and socialize at brick-and-mortar PACE facilities.

Sachin Jain, M.D., CEO of SCAN Group and SCAN Health Plan, is a well-known thought leader and frequently shares ideas on improving health care as a contributor to Forbes. AIS Health, a division of MMIT, spoke with Jain to learn more about its commitment to PACE and to discuss some of the broader challenges facing not-for-profit insurers.

A confluence of factors could contribute to millions of people enrolled in Affordable Care Act exchange plans losing their coverage, which may lead to a less healthy population and significantly increase health care costs, according to speakers at a KFF webinar on June 11.

Pat Kelly, executive director of the Your Health Idaho marketplace, said there is “a lot of uncertainty all at once” and “a lot of change” in the market, while Michele Eberle, executive director of the Maryland Health Benefit Exchange, noted that the proposed shift in the ACA coverage “really poses significant challenges for our states.”

With policy changes looming that could drastically reduce access to $0-premium health plans on the Affordable Care Act exchanges, a new study offers a glimpse into how consumers might respond.

“It’s extremely relevant for next year,” says David Anderson, an assistant professor at the University of South Carolina who was one of the study’s coauthors.

Louisiana Attorney General Liz Murrill on June 12 sent a cease-and-desist letter to CVS Health Corp., asking the firm to stop sending customers “unsolicited and unwanted text messages for political reasons.” The letter, which Murrill posted on the social media platform X, said her office received information that CVS improperly appropriated the personal contact information of Louisiana customers and sent text messages that urged them to oppose House Bill 358, a now-failed measure which would have prohibited companies from owning both PBMs and pharmacies. Arkansas recently passed a similar bill, drawing lawsuits from CVS, The Cigna Group, and PBMs’ main trade group. Murrill, a Republican, warned CVS in her letter that its use of Louisiana citizens’ personal information in the way described could violate state law.