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The ACA individual market risk pool is getting smaller and sicker, with risk scores rising 6.3% even as enrollment fell…
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Healthcare consumers no longer benchmark their experiences against other hospitals. They benchmark them against every digital experience they have — banking, retail, travel, entertainment — and they expect the same convenience, transparency, personalization and seamless communication from their care. Most…
Presented by:
- Veronique Au, MD, National Physician Director, Ambulatory Medicine Vituity
- Michael Antoniades, President, Ingalls Memorial Hospital UChicago Medicine
Crissy Turino became a member of CountyCare — a Medicaid plan under Chicago-based Cook County Health, a public health system — about two years after it launched. She is now one of the plan’s top leaders, serving as COO. Ms.…
Health insurers released their second-quarter earnings from mid-July through early August, with all but Elevance Health posting year-over-year profit gains. Earnings for the major payers coincided with the release of the Fortune Global 500. UnitedHealth Group moved up to become…
Payment integrity has long been constrained by audit capacity and review quality. When teams only audit what they’re staffed to handle and consistency varies widely across reviewers, it’s difficult to measure true hit rates or maintain quality at scale. AI…
Presented by:
- Shri Santhanam, Chief Product Officer, Machinify
- Emma Nasif, Chief Legal Officer, Machinify
- Vijay Bharadwaj, Chief AI Scientist, Machinify
Federal enforcement around Medicare Advantage risk adjustment and billing has ramped up over the past two years, producing multimillion-dollar settlements with insurers, provider groups, and the vendors that handle their diagnosis coding. The combined value of the settlements comes to…
CMS’s expanding RADV audit activity is changing the economics of risk adjustment. The question is no longer whether organizations can optimize retrospective chart chase. The question is whether their operating model can withstand continuous audit scrutiny at enterprise scale. Retrospective…
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CVS Health brought in nearly $3 billion in profit for the second quarter of 2026, up from $1 billion during the same period in 2025. Total revenue was $106.1 billion for the quarter, a 7.3% year-over-year increase. The company lifted…
In 2026, Aetna offers the best digital experience among major insurers on both desktop and mobile, according to new research from Corporate Insight shared with Becker’s. Corporate Insight’s “2026 Commercial Health Plan Experience Benchmark,” published Aug. 5, evaluated 24 commercial…
For most health systems, the pharmacy is treated as a cost center. A growing number are proving it can be a growth engine instead, and KLAS just took a closer look at how. In its first Emerging Company Spotlight on…
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Jacksonville, Fla.-based management services organization Complete Health Partners Holdings has agreed to pay $14.1 million to settle allegations that it violated the False Claims Act by causing false diagnosis codes to be submitted to boost Medicare Advantage payments. The settlement…
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Hiring for jobs that don’t exist yet: How Grady Health System is building healthcare’s next workforce
Presenters: Luisa Kurtz, AMN HealthcareTanner Burch, AMN HealthcareRick Roche, Grady Health System
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