5 recent payer moves to know

Here are five updates on some of the U.S.' largest payers that ASC leaders should know:

1. Humana's value-based care efforts in Medicare Advantage saved around $8 billion (23.2%) in 2022 compared to costs of traditional Medicare. In 2022, around 70% of Humana's Medicare Advantage members were in some form of value-based care relationship, the highest proportion since the company began publishing value-based care reports in 2013. 

2. Insurance giant UnitedHealth Group is facing a lawsuit alleging it used an artificial intelligence algorithm to wrongfully deny coverage to older patients for care under its Medicare Advantage health policies. 

3. The Blue Cross Blue Shield Association allegedly allowed federal employees' sensitive medical information to be obtained by third-party technology companies, including TikTok, according to a lawsuit filed Nov. 7. The lawsuit was filed by five former federal health plan enrollees who are seeking class-action status and a jury trial. The plaintiffs allege that BCBSA's website for federal policyholders uses tracking technology that allows third-party organizations such as TikTok "to secretly intercept and record the employees' communications and activities on the website in real time, including specific searches for sensitive health-related topics."

4. New York fined five Medicaid managed care plans a total of $2.6 million following an examination of their reimbursement of behavioral health claims that found "repeatedly and inappropriately denied claims" or failure to pay for services at rates required by law.

5. Major health insurers are offering Medicare Advantage plans in more counties in 2024 than they did in 2023, according to a Nov. 8 report from KFF. Here are the number of counties in which seven payers are offering Medicare Advantage plans in 2024 and how those figures compare to 2023.

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