Today's Top 20 Stories
  1. Most states offer Medicare Advantage plans to retired employees: 5 things to know

    In 2024, 36 states offered Medicare Advantage plans to retired employees, according to a report from KFF published May 23. 
  2. Aetna to challenge Kansas Medicaid contract awards, UCare stands down

    Aetna plans to protest Kansas' Medicaid contract awards, while UCare will stand down after losing an effort to win a contract in the state. 
  3. 5 prior authorization updates

    From two states passing reform laws to an Oregon health system making prior authorization 'a thing of the past' for cancer treatment, here are five prior authorization updates Becker's has reported since  

The state of AI in healthcare

86% of healthcare leaders say AI will define success over the next 5 years. Insights + strategies for successful adoption here.
  1. Blue Shield of California names chief actuary

    Blue Shield of California has named Kassie Maroney as senior vice president and chief actuary.
  2. Senator urges crackdown on fraudulent ACA brokers

    The chair of the Senate Finance Committee is urging CMS to do more to stop fraud on ACA exchanges, KFF Health News reported May 21. 
  3. UnitedHealth wants Medicare Advantage algorithm denials suit tossed

    UnitedHealth Group said a proposed class-action lawsuit alleging an AI algorithm wrongfully denied Medicare Advantage patients care should be dismissed because "plaintiffs have failed to exhaust the exclusive administrative appeal process set by the Medicare Act for challenging coverage determinations."
  4. New York City continues push for Aetna Medicare Advantage plan

    New York City Mayor Eric Adams plans to ask the state's highest court to allow the city to implement an Aetna Medicare Advantage plan for its retired employees, the New York Daily News reported May 21.

How one Midwest hospital is driving financial efficiency with interconnected systems

Major time savers can stem from single logins. That's how 1 hospital achieved a 50% reduction in month-end close time — read the short case study, here.
  1. New York health plans pitch merger

    Two New York health plans intend to merge, creating an organization with nearly 2 million members and 6,000 employees. 
  2. 10 payers among Forbes' best employers for new grads

    10 payers were named in Forbes' annual "America's Best Employers for New Grads" list, published May 21.
  3. Another state tackles prior authorization

    An Oklahoma bill reforming the prior authorization process has been signed into law and goes into effect Jan. 1, The Journal Record reported May 21. 
  4. 7 providers being acquired by payers

    Payers are continuing to snap up providers. 

How one Midwest hospital is driving financial efficiency with interconnected systems

Major time savers can stem from single logins. That's how 1 hospital achieved a 50% reduction in month-end close time — read the short case study, here.
  1. States ranked by ACA enrollment growth since 2020

    The ACA marketplace hit a record enrollment high of 21 million in 2024, buoyed by federal premium subsidies. In 2020, ACA enrollment was 11 million.
  2. Medicare Advantage in the headlines: 7 recent updates

    More hospitals are cutting ties with Medicare Advantage plans, and some insurers are bracing for membership losses in 2025. Here are seven Medicare Advantage updates Becker's has reported since May 8. 
  3. Centene plans $900M affordable housing investment

    Through pre-development loans, Centene and building developer McCormack Baron Salazar will enable around $900 million in planning and construction-related activity to accelerate the development of affordable housing. 
  4. Vermont governor signs prior authorization reform bill

    Vermont Gov. Phil Scott has signed a bill to reform the prior authorization process in the state.
  5. GuideWell subsidiary notifying 2.4 million members of data breach 

    GuideWell subsidiary WebTPA, a health benefits administrator, has started notifying more than 2.4 million members about a data breach that occurred in April 2023, The HIPAA Journal reported May 20.
  6. 13 payers cutting jobs | 2024

    Payers are trimming their workforces and cutting jobs due to financial or operational challenges, along with restructuring strategies. 
  7. Promise of VBC: The imperative of care management programs to focus on low-risk members

    Preventive care delivery is one of the inalienable levers of value-based care (VBC). With the increasing VBC adoption, many healthcare payers have been offering care management programs that aim to promote overall member wellness by managing members’ medical conditions and preventing progression of chronic diseases.
  8. 8 recent payer lawsuits, settlements

    Here are eight lawsuits, settlements and legal developments involving payers that Becker's has reported since April 1: 
  9. 10 key questions facing Medicare Advantage

    Medicare Advantage is the dominant form of Medicare, and questions loom for payers, providers and policymakers alike in the year ahead. 

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