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Health Plan CEO Comp Drops Slightly

Health insurance CEO pay dipped slightly in 2025 as companies struggled financially. CEO comp dropped at Centene, Cigna and Molina Healthcare and rose at UnitedHealth Group, Elevance Health, Aetna parent company CVS Health, Humana, Alignment Health and Oscar Health.

The average compensation package for the nine CEOs was $16.7 million in 2025, down less than 2% from 2024.

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#compensation #healthplans

https://www.modernhealthcare.com/insurance/mh-insurance-ceo-compensation-2025-unitedhealth-humana

Health Plans Continue Prior Authorization Reforms

Two insurance lobbies, AHIP and the Blue Cross Blue Shield Association, said that leading health plans continue to make significant progress to adopt a standardized approach for providers submitting electronic prior authorization (PA) requests for the majority of medical services. About 88% of Aetna’s prior authorizations already adhere to the standards, with UnitedHealthcare and Cigna saying their standards will apply to more than 70% of their PA volume by the end of the year.

Key reforms include reducing the number of services subject to prior authorization as well.

In addition, lawmakers proposed bipartisan legislation aimed at strengthening Medicare Advantage (MA) plan oversight to ensure seniors receive timely and high-quality care. The bill aims to address barriers to coverage and treatment, including:

• Strengthening oversight and accountability for plans failing to meet compliance standards
• Increasing transparency and streamline prior authorization processes
• Aligning coverage criteria with traditional Medicare
• Reducing administrative burdens through real-time, automated systems 
• Expanding access to post-acute care providers

Additional articles: https://www.fiercehealthcare.com/payers/unitedhealthcare-aetna-tout-progress-standardize-prior-authorization-part-industry-wide and https://www.modernhealthcare.com/insurance/mh-cigna-humana-prior-authorization-standardized-requirements/

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#healthplans #priorauthorization #providers

https://www.fiercehealthcare.com/regulatory/lawmakers-introduce-bipartisan-legislation-improve-access-quality-care-medicare

Paragon Urges Hospital Payment Reform

The influential Paragon Institute, which influenced the One Big Beautiful Bill Act (OBBBA) and no extension of Exchange enhanced subsidies, has issued a new report challenging hospitals’ views on their finances and advocating payment reform.

About one third of over $5 trillion each year is spent on hospital care and Paragon notes that hospitals are a key factor in driving premiums given major cost hikes annually. It notes that since 2000 hospital prices have risen three times faster than inflation and double wage growth. It says government policies inflate and distort hospital prices as well as encourage consolidations and physician acquisition. It argues hospitals can make money at Medicare rates and hospitals have had strong positive margins. It calls attention to the success of some hospitals with large government program patient loads.

Paragon proposes a number of reforms below. Hospital groups took issue with the financial characterizations as well as proposals. But reform appears to be fermenting in Congress.

The proposed reforms include:

• Site-neutral payments in Medicare
• Medicare rate setting based on Medicare Advantage price transparency data
• Further Medicaid provider tax and state-directed payment restrictions
• Oversight of hospital supplemental payments
• Development of a comprehensive inventory of federal hospital payments
• Better targeting of 340B net savings to in-need entities or individual patients directly
• Repeal of state’s certificate of need laws
• Repeal of restriction on reimbursement to new physician-owned hospitals
• Increased oversight of hospitals’ compliance with tax rules
• Increased enforcement of hospital and insurer price transparency
• Removal of uncompensated care payments from Medicare and moving to targeted payments based on share of charity care and non-Medicare bad debt
• Elimination of the current graduate medical education (GME) funding formula in favor of discretionary grants

Additional article: https://paragoninstitute.org/private-health/the-hospital-cost-crisis-how-government-policies-drive-consolidation-undermine-competition-and-fuel-soaring-prices/?nab=0

#hospitals #siteneutral #payments

https://www.fiercehealthcare.com/providers/conservative-think-tank-paragon-health-calls-its-shots-hospital-policy-reform

Elevance Beats The Street

Elevance Health beat Wall Street expectations for Q1 2026 and raised its full-year guidance. It has instituted a performance improvement and turnaround program and is managing medical costs. The company reported $1.8 billion in Q1, down 19.2% from $2.2 billion in the prior-year quarter.

Revenue in the quarter was $50.2 billion, up 2.6% from Q1 2025. Elevance had a $1.76 billion profit in Q1, down 19.4% year over year.

It continues to have struggles in Medicare Advantage (MA) and Medicaid. On MA, it faces a potential exposure over risk adjustment of up to $1.5 billion. On Exchanges, it reports that more and more are choosing cheaper Bronze plans due to premium hikes and enhanced subsidy expiration.

Elevance also says it will invest $1 billion in digital and AI capabilities.

Additional articles: https://www.modernhealthcare.com/insurance/mh-elevance-health-earnings-stock-price/ and https://www.beckerspayer.com/virtual-care/inside-elevances-1b-ai-investment/ and https://www.beckerspayer.com/financial/elevance-reports-1-76b-profit-in-q1/ and https://www.fiercehealthcare.com/payers/elevance-health-raises-2026-outlook-it-posts-18b-q1-profit

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#elevancehealth #healthplans #margins #medicareadvantage #exchanges #aca #medicaid

https://www.healthcaredive.com/news/elevance-raise-2026-profit-outlook-cms-medicare-advantage-payout/818122

— Marc S. Ryan

GLP-1 BALANCE Model On Hold

The Trump administration’s effort to bring GLP-1 drugs for the obese to Medicare, BALANCE, is on hold. The Centers for Medicare and Medicaid Services (CMS) planned to negotiate lower GLP-1 prices for Medicaid and Medicare Part D coverage and have health plans and pharmacy benefits managers (PBMs) agree to offer the drugs in the programs. But too few applicants applied to participate, likely due to costs and risk. Critical mass in Part D, covering 80% of Part D enrollment, was not met. The Medicaid portion of the pilot will still move forward. In Medicare, to gather necessary data, CMS now plans on funding coverage via the temporary BRIDGE pilot through the end of 2027 before proceeding again with BALANCE.

At the same time, UnitedHealthcare said it was hoping to participate in both the BRIDGE program in 2026 and in BALANCE.

Additional articles: https://www.beckershospitalreview.com/glp-1s/cms-pauses-weight-loss-balance-model-indefinitely-for-medicare/ and https://www.beckerspayer.com/payer/medicare-advantage/unitedhealthcare-eyes-cms-balance-glp-1-model/

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#glp1s #weightlossdrugs #drugpricing #medicare #partd #medicareadvantage #pdp #medicaid #managedcare

https://www.modernhealthcare.com/politics-regulation/mh-medicare-glp-1-weight-loss-coverage

United To End Most PAs On Rural Hospitals

Responding to the rural health crisis and its own bad PR, UnitedHealthcare says it will exempt rural hospitals from most prior authorizations. This will apply across all lines of business. United will also accelerate payments by up to 50% for about 1,500 rural hospitals and all critical access hospitals across the country.

Additional article: https://www.beckerspayer.com/payer/unitedhealthcare-pares-back-prior-authorizations-speeds-up-payments-for-rural-providers/

#unitedhealthcare #priorauthoriztaion #ruralhealthcare

https://www.fiercehealthcare.com/payers/unitedhealthcare-unveils-pilot-accelerate-payments-rural-hospitals

PCP Stability In Doubt

Elation Health finds that over 80% of primary care physicians (PCPs) are concerned about financial stability over the next several years. The company surveyed 280 PCPs from Jan. 31 to Feb. Fifty-two percent of respondents were fully independent and 48% have some affiliation. 

About 64% cite government and commercial payer reimbursement as their top concern. Staffing costs, workforce challenges, technology and IT costs and rising operational costs are also challenges.

Despite all this, 93% of respondents report remaining committed to primary care. Only 2% report planning to leave the practice. 

#providers #physicians #margins

https://www.fiercehealthcare.com/providers/over-80-pcps-concerned-about-financial-stability-over-next-several-years-elation-health

Trump Getting Serious On Affordability

There was a clear sign today that the Trump administration is worried about the impact of the lack of healthcare affordability. The Trump administration created a top-level healthcare position that will be a de facto affordability czar. Health and Human Services Secretary Robert F. Kennedy, Jr. has named Casey Mulligan as chief economist and chief regulatory officer of the agency. He’ll advise Kennedy and other agency leaders on affordability issues.

Mulligan was on the Council of Economic Advisers during the first Trump administration and was most recently the U.S. Small Business Administration’s chief counsel for advocacy.

Meanwhile, healthcare policy group KFF issued a briefer on Americans’ views of healthcare. Just under half of U.S. adults say it is difficult to afford healthcare costs, and about three in ten say they or a family member in their household had problems paying for healthcare in the past 12 months. Further, 36% of adults say that they have skipped or postponed getting healthcare they needed because of cost. About 75% of uninsured adults under age 65 say they went without needed care because of cost.

KFF also just added an employer insurance chapter to its online resource on healthcare. It dives deep into all things employer coverage.

Additional articles: https://www.kff.org/health-costs/health-policy-101-employer-sponsored-health-insurance/?entry=table-of-contents-resources and https://www.kff.org/health-costs/americans-challenges-with-health-care-costs/

#affordability #healthcare #healthcarereform #coverage

https://www.axios.com/2026/04/16/hhs-health-care-affordability-midterms

— Marc S. Ryan

Chronic Care Cost-Sharing Targeted

A new bill would eliminate Medicare cost-sharing on care coordination services. Supporters argue the cost-sharing on the services creates financial barriers to deploying such services for many. They also argue charging seniors for the behind-the-scenes services is confusing. Further, the services have documented savings, but utilization is low due to the cost-sharing impediment. About 40 healthcare and patient groups have endorsed the measure.

#chroniccare #medicare

https://www.fiercehealthcare.com/providers/providers-back-new-bipartisan-bill-eliminating-medicare-chronic-care-management-cost

Bill Would Force Insurers To Count DTC Drugs Against Deductible, MOOP

North Carolina Republican Rep. Greg Murphy, MD, has introduced a new bill that would compel insurers to apply the cost for drugs purchased from direct-to-consumer (DTC) platforms to deductibles and out-of-pocket maximums (MOOPs) in insurance. Using these platforms, patients can often find prices that cost far less out-of-pocket, especially for brand drugs, Murphy’s office said.

#drugpricing #dtc #branddrugmakers #healthplans

https://www.fiercehealthcare.com/regulatory/bill-seeks-force-payers-apply-dtc-drug-purchases-patient-deductibles