AHIP Solutions SmartBrief
Plus: Ozempic, Wegovy price cut
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November 18, 2025
 
 
AHIP Solutions SmartBrief
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Top Story
 
Oz says all options on table for ACA subsidies
 
NEW YORK, NEW YORK - JULY 14: Administrator of the Centers for Medicare & Medicaid Services (CMS) Dr. Mehmet Oz visits "Varney & Co." at Fox Business Network Studios on July 14, 2025 in New York City. (Photo by John Lamparski/Getty Images)
Oz (John Lamparski/Getty Images)
CMS Administrator Mehmet Oz said the Trump administration is open to all options as Affordable Care Act subsidies are set to expire at year's end. President Donald Trump has proposed direct payments to Americans instead of insurers, while House Democrats are pushing for a three-year extension of the subsidies.
Full Story: Fortune (tiered subscription model) (11/16)
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The Role of Clinical Guidelines in the AI Era
Explore how human decision-making, combined with AI technology rooted in evidence-based guidance, can improve decision accuracy, transparency, and member care.
Read the blog here.
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Providers & Suppliers
 
Wage gaps in health care shrunk during pandemic
The COVID-19 pandemic period saw significant wage increases for some health care workers, particularly those in lower-earning positions. Aides and assistants experienced the biggest gains with a 13.6% increase. In contrast, registered nurses saw an increase of 3.8% and technicians 1.1%. Advanced practice providers' wages rose 8.3%.
Full Story: Becker's Hospital Review (11/17)
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Taking the pulse on behavioral health benefits
Your practices are crucial. Join fellow health plan leaders in shaping the conversation — complete the survey to see how your peers are navigating behavioral health strategy and integration.
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Medical Update
 
Emerging H3N2 strain could challenge US health system
A new H3N2 influenza strain could pose a significant challenge to the US health care system, according to international reports. The strain has caused a surge in cases in the UK, particularly among young adults and children, and has acquired several mutations, making it different from the strain included in this year's vaccine. The CDC has yet to provide updated national data because of recent disruptions, but experts recommend vaccination for protection.
Full Story: Medscape (11/14)
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Premature death rate on the rise for under-65 adults
Premature deaths among adults younger than 65 increased 27% from 2012 to 2022, with Black adults experiencing a higher rate than white adults, according to a study in JAMA Health Forum. The research highlights the health outcome impact of societal factors such as lack of health insurance, rising living costs and a weak social safety net, and notes that chronic diseases are a major cause of these premature deaths.
Full Story: The Washington Post (11/7)
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The Three Pillars of COB Success for Health Plans
Reduce medical costs and improve member satisfaction with a stronger coordination of benefits program and a complete payment integrity strategy. Read the eBook.
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Emerging Trends: Social Determinants of Health
 
Income disparities affect childhood vaccination rates
Significant disparities exist in vaccination rates among different income groups, with only 62.3% of low-income children receiving all early childhood vaccines, compared with 77.9% of high-income children. The Commonwealth Fund report highlights logistical barriers, such as transportation and scheduling issues, contributing to these disparities.
Full Story: TechTarget (11/17)
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10.4% preterm birth rate earns US a D+ again, report says
The US received a D+ for its 10.4% preterm birth rate for the fourth consecutive year, according to a March of Dimes report. The report highlighted significant disparities, with a 9.5% preterm birth rate for babies born to white mothers, compared with 14.7% for babies born to Black mothers. Data showed improved preterm birth rate percentages in 19 states, while the numbers worsened in 21 states, according to the CDC.
Full Story: Axios (11/17)
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Social deprivation tied to higher diabetic retinopathy risk
Research from the Keck School of Medicine indicates that social deprivation, including low income and housing instability, is linked to a higher incidence of diabetic retinopathy in patients with type 2 diabetes, even when treatment adherence is maintained. The study, published in Eye, analyzed data from 3.7 million patients and found that socially deprived individuals experience more severe progression and complications, such as retinal detachment and macular edema, over a decade.
Full Story: Healio (free registration) (11/14)
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Health Plan Company News
 
 
Aflac expands support for children with new book 'Beyond Words'
 
 
AmeriHealth Caritas Adds New States and Counties to Its Health Insurance Marketplace Footprint
 
 
AmeriHealth Caritas Names Gregg MacDonald Interim President
 
 
Blue Cross NC, Comfort Cases Launch ‘Pathway to Comfort’ for N.C. Kids in Foster Care
 
 
CareSource: Cincinnati Bengals Support Shoes 4 the Shoeless with a Sock Drive at Patriots Game on November 23 as part of NFL’s My Cause My Cleats league-wide initiative
 
 
Clearity by Cigna Healthcare, A New Tech-Enabled Health Plan Offers Customers Transparent, Predictable Prices
 
 
The Cigna Group and Earvin "Magic" Johnson Team Up to Help Boys & Girls Club Kids Impacted by Southern California Wildfires
 
 
Commonwealth Care Alliance Senior Care Options Plan Achieves 4 Star Quality Rating from CMS