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Most Small Health Plans Struggle To Thrive In California Insurance Marketplace
About 96 percent of Covered California customers are picking among the "big four" plans, according to a "Road to Reform" analysis of October and November enrollment figures. (Based on off-the-record interviews with several health plan officials, a similar trend continued through December).
About 96 percent of Covered California customers are picking among the "big four" plans, according to a "Road to Reform" analysis of October and November enrollment figures. (Based on off-the-record interviews with several health plan officials, a similar trend continued through December).
Exchange officials take issue with that characterization. "While the majority of enrollment across the state is in four plans, it's different when you look region by region," Executive Director Peter Lee said in December.
However, a region-by-region look shows that's not true. "Road to Reform" analysis reveals that those four plans commanded 100 percent of sign-ups in nine of Covered California's 19 regions, and captured at least 95 percent of market share in seven other regions.
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.
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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.
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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.
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