Revenue Cycle and Payer News – November 6, 2024

Cohere Health and MCG Partner to Deliver Best-in-Class Prior Authorization Solution
Cohere Health®, a provider of clinical intelligence and prior authorization automation, and MCG Health, part of the Hearst Health network and a provider of technology-enabled, evidence-based guidance, announced they will integrate their content and technology offerings to improve the prior authorization process for providers, patients, and health plans.

Emory Healthcare and Anthem Blue Cross and Blue Shield Continue Collaboration for Better Health Outcomes
Emory Healthcare and Anthem Blue Cross and Blue Shield will continue their health care collaboration through 2028 providing access to quality care for the more than 140,000 members the systems serve.

Humana and Longevity Health Multi-State Agreement Expands Access to Humana Together in Health Special Needs Plans
Humana Inc., a health and well-being company, and Longevity Health, a clinical services company dedicated to serving vulnerable individuals living in a long-term care facility, have announced that eligible residents of long-term care facilities in Indiana, Iowa, Kentucky, Louisiana, New Mexico, Tennessee, Washington, and West Virginia will have access to Humana Together in Health, a Medicare Advantage Institutional Special Needs Plan (I-SNP), starting in 2025.

Aetna introduces SimplePay Health
Aetna, a CVS Health company, now offers SimplePay Health, an alternative health plan designed to further meet the diverse needs of our clients and members. This plan, for self-insured clients, works to further reduce costs, improve health outcomes and simplify the health care experience through a differentiated approach to health care coverage.

Oscar Health Announces 2025 Market Expansion to Put Health Insurance in the Hands of More Americans
Oscar Health, Inc., a healthcare technology company, announced it will bring the Oscar experience to more individuals, families, and businesses through the ACA marketplace in 2025. Oscar is introducing affordable health insurance products that empower people to pursue a healthy life on their terms.

UnitedHealthcare Expands its Individual & Family Plans on the Health Insurance Marketplace to 30 States
UnitedHealthcare has announced a significant expansion of its Individual & Family Affordable Care Act (ACA) Marketplace plans, now offering coverage in 30 states. This increase includes new coverage areas in Indiana, Iowa, Nebraska and Wyoming, as well as additional counties in 13 other states.

Humana Reports Third Quarter 2024 Financial Results; Updates Full Year Adjusted 2024 Financial Guidance
Humana Inc. reported consolidated pretax results and diluted earnings per share (EPS) for the quarter ended September 30, 2024 (3Q24) versus the quarter ended September 30, 2023 (3Q23) and for the nine months ended September 30, 2024 (YTD 2024) versus the nine months ended September 30, 2023 (YTD 2023) as noted in the tables below.

UnitedHealth Group Reports Third Quarter Results
UnitedHealth Group reported third quarter 2024 results reflecting broad-based growth in the number of people served by Optum and UnitedHealthcare.

Requirements Related to the Mental Health Parity and Addiction Equity Act
A Rule by the Internal Revenue Service, the Employee Benefits Security Administration, and the Health and Human Services Department regarding health plans and mental health.

Centene Named One of Fortune’s 100 Best Large Workplaces for Women 2024
Centene Corporation, a healthcare enterprise committed to helping people live healthier lives, announced that it has been named to the 2024 Fortune 100 Best Large Workplaces for Women™ list for the second consecutive year.

Aetna shines in Star Ratings with 88 percent of Medicare Advantage members in 4-star plans or higher for 2025
Aetna®, a CVS Health® company, announced that 88 percent of its Medicare Advantage (MA) members are in 2025 Medicare Advantage Prescription Drug (MAPD) plans that are rated 4 stars or higher (out of 5 stars) by the Centers for Medicare & Medicaid Services (CMS).

Humana Ranks #1 Among Health Insurers for Customer Experience for the 4th Year in a Row
For the fourth consecutive year, Humana ranks No. 1 among health insurers for customer experience (CX) by Forrester.* Humana received the highest CX Index™ score among Health Insurers in Forrester’s proprietary 2024 CX Index™ survey. The results are based on 12,372 consumers’ opinions of the experiences with the 16 brands in the survey.

CareFirst Named No.2 in Customer Experience Among U.S. Health Insurers
CareFirst BlueCross BlueShield (CareFirst), one of the country’s largest not-for-profit healthcare organizations, announces its ratings placement as No.2 on the U.S. Health Insurers’ 2024 Customer Experience (CX) Index Rankings, and the only U.S. health insurer to increase in CX rating over last year.

Cigna Healthcare Announces 2025 Marketplace Plans, Offering Quality, Affordable Health Care
Cigna Healthcare will provide affordable, comprehensive health care plans in 11 states through the individual marketplace in 2025, marking the 11th consecutive year Cigna Healthcare has participated in the Affordable Care Act (ACA) marketplace.

Independence Blue Cross announces 2025 benefits for large employers
Independence Blue Cross (IBX) announces its 2025 commercial medical and prescription drug product health plans for large employers headquartered in southeastern Pennsylvania with 51 or more employees.

Drug and Hospital Costs Account for Nearly Two-Thirds of Americans’ Health Care Dollar by AHIP – Nearly one quarter of every dollar Americans pay for health care premiums now goes to prescription drug costs, while hospital costs account for over 40 cents of that dollar, a new AHIP analysis of commercial health care premiums shows.

HealthEdge® Survey Reveals Top Health Plan Priorities for 2025 – HealthEdge®, a provider of healthcare technology solutions, has released its annual survey of the healthcare payer market revealing the top priorities, investments, and challenges for the coming year.

AHIP 2025 (@AHIPCoverage)

What: AHIP 2025
When: June 17-19, 2025
Where: Seattle, Washington
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Experience what’s next in health care at AHIP 2025 (Formerly Institute & Expo), building on AHIP’s decades-long heritage of bringing together the people, ideas, and solutions guiding greater health for years to come.