- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Growing Pains for Medicaid Managed Care Expansions
Although they're not expanding Medicaid under the Affordable Care Act, Texas, Florida and other states are expanding managed care, bringing insurers opportunities as well as challenges, including competition from provider-based health plans.
Although they're not expanding Medicaid under the Affordable Care Act, Texas, Florida and other states are expanding managed care, bringing insurers opportunities as well as challenges, including competition from provider-based health plans.
In Texas, the unduplicated enrollment numbers in Medicaid managed care programs total approximately 2.84 million residents, and Superior HealthPlan, a subsidiary of Centene, and Amerigroup, a subsidiary of WellPoint, have received the bulk of managed care organization contracts over the past few years.
The Texas Health and Human Services Commission's managed care contracts include requirements that organizations have sufficient capacity to serve the expected enrollment, meet service area needs with geographic distribution of preventative, primary care, and specialty service providers, and report how often members go out of network.
Read the full story here: http://bit.ly/1myLSad
Source: Healthcare Payer News
Health Care Utilization and Cost of Diagnostic Testing for Respiratory Infections
September 17th 2025Syndromic reverse transcriptase–polymerase chain reaction tests for respiratory infections were associated with lower health care resource utilization and costs, implicating potential for improved value in patient care.
Read More
AI in Health Care: Balancing Governance, Innovation, and Trust
September 2nd 2025In this conversation with Reuben Daniel, associate vice president of artificial intelligence at UPMC Health Plan, we dive into how UPMC Health Plan builds trust with providers and members, discuss challenges of scaling AI effectively, and hear about concrete examples of AI's positive impact.
Listen
Infertility Coverage Boosts ART Use and Pregnancy Success: Richard A. Brook, MS, MBA
August 26th 2025In this episode, Richard A. Brook, MS, MBA, discusses his study showing that infertility treatment coverage increases assisted reproductive technology (ART) use and improves pregnancy outcomes.
Listen
