BlueCross BlueShield of South Carolina is the dominant insurer in the market and state and relies on its clout and size when doing business, leaving it to health systems to drive change. Health systems are scrambling to build facilities in medically underserved Berkeley and Dorchester counties to drive growth in patient volume and gain favor with payers. Projects in Berkeley range from Roper St. Francis Healthcare 's new acute-care hospital to Tenet Healthcare 's East Cooper Medical Center's plans to build a freestanding emergency department in Berkeley County. Humana has opened two primary-care clinics in the market to serve its Medicare Advantage members, which could help grow its MA enrollment. The state is seeking a Medicaid work requirement, which if approved, could result in some recipients losing Medicaid benefits and decreased enrollment for Medicaid MCOs.

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