AHIP

Health plans are working to reduce the rate of chronic disease by 10% over the next decade. Progress towards this goal will require a broad, coordinated, collaborative approach, and health plans are committed to doing their part to reduce the burden of chronic disease. Learn more: https://lnkd.in/dUsPykSw

Since coming together to make a multi-year series of voluntarily commitments to streamline and simplify prior authorization, health plans have been working to ensure this critical safeguard is focused on the services where it is most needed and to ensure continuity of care for patients when they switch health plans. Work is also underway to advance electronic prior authorization, which will deliver a faster and more consistent experience to patients and providers.

A new investigative report by NBC News underscores how hospital systems’ anticompetitive consolidation, ever-higher prices and opaque billing practices are raising health care costs and driving the ongoing affordability crisis. Some key excerpts: —“Hospital costs are among the major forces driving Americans deeper into debt and widening the inequality gap. Over the past two decades, those costs have risen far faster than any other sector of the U.S. economy, said Zack Cooper, associate professor of public health at Yale University. Paying for hospital care is ‘the leading driver of health spending growth,’ Cooper said. ‘And the genesis of a lot of the affordability pressure folks are feeling has to do with health care.’” —“How much does a particular procedure cost at your nearest hospital? It’s supposed to be easy to find out. Federal rules went into effect in 2021 requiring hospitals to provide such information in a ‘consumer-friendly format.’ But pricing information on hospital websites can be hard to grasp owing to huge data files and the complex way it’s presented. An analysis of pricing at half the nation’s hospitals — a total of 3,236 facilities — shows that the costs of the same procedures are literally all over the map.” —“Experts say a major driver of hospital costs is industry consolidation—hospital systems acquiring other facilities. A 2024 research paper co-authored by Yale's Cooper found that from 2010 to 2015, anticompetitive mergers of hospitals raised prices by more than 5%.” Read the full NBC News report: https://lnkd.in/eBA-Jkpn

Employer-provided coverage remains the backbone of the American health care system, and nearly nine in 10 Americans with employer-provided coverage report satisfaction with their coverage. Learn more: https://lnkd.in/ed6_u3jt

More than 3 in 4 American adults have at least one chronic disease, creating significant challenges for patients while also putting strain on the health care system. Reducing the burden of chronic disease requires shared commitment across the health care system, and health plans are well-positioned to play a key role. Learn more about how plans are addressing chronic disease: https://lnkd.in/dUsPykSw

ICYMI: New research pulls back the curtain on how some hospital systems are suing patients and garnishing their wages while they continue to drive Americans’ premiums higher through anticompetitive consolidation, opaque billing practices and unaffordable price hikes. https://lnkd.in/eNVXE7Nt

The individual market is an essential source of coverage for 20 million Americans—including working families, small business employees, family farmers and gig workers. Health plans are working to support consumers in this market with the most affordable coverage choices possible. 

A new data analysis published in Health Affairs shows provider-driven abuse of the No Surprises Act accelerating as bad actors relentlessly exploit the law’s arbitration process to pad their own profits at Americans' expense. Dispute volume in the first half of 2025 more than doubled from the same period in 2024—driven largely by a small number of private equity-backed providers and IDR middlemen effectively rigging the system to extract payouts that can be "three to nine times in-network rates.” Some key excerpts from the analysis: —“In the first six months of 2025, providers and facilities initiated 99.9 percent of all disputes while plans initiated 0.01 percent. Of the provider-initiated disputes, 80 percent were submitted by providers while 20 percent were submitted by facilities.” —“Four provider groups and provider representatives—mostly backed by private equity—initiated the majority of these disputes...” —“Providers also won 88 percent of disputes—the highest provider win rate to date—as compared to 85 percent in 2024 and 81 percent in 2023.” —“For the first two quarters of 2025, Radiology Partners secured median awards of 582 percent and 594 percent of QPA, respectively. SCP Health won median awards of approximately 370 percent of QPA in both quarters, and Team Health won award amounts at a median of 277 percent of QPA.” —“Of the top four initiating parties, HaloMD’s award amount far outpaced the others, with median payments of 920 percent and 835 percent of QPA in the first two quarters of 2025, respectively.” —“The ever-increasing volume of cases has contributed to higher administrative costs … In the first half of 2025, these fees totaled $844 million. This amount is staggering on its own. But it is even more alarming that this amount—for a six-month period—is nearly equivalent to the total of $885 million in administrative fees from 2022 to 2024.” —“The high fee amount in just six months suggests that IDR-related administrative costs are escalating quickly and that our prior estimate of $5 billion in total IDR-related costs through the end of 2024 will have risen substantially by the end of 2025.” Read more here: https://lnkd.in/eniykHSy

Medicaid serves clinically complex populations and Americans facing economic insecurity. It serves people who work hard in demanding jobs that often don’t include health care benefits, and it is essential to the stability of health care systems nationwide. Amid significant changes coming to Medicaid, health plans are working at the federal and state levels to support beneficiaries, promote access and ensure system stability.

Affordability is the key issue at every kitchen table across our country. AHIP is advancing common-sense bipartisan solutions to improve affordability by tackling the root causes of higher health care costs.