Today's Top 20 Stories
  1. OIG: 14 states paid managed care organizations $249M for deceased Medicaid enrollees

    Fourteen states gave managed care organizations payments for Medicaid enrollees for months after beneficiaries had died, a series of HHS Office of Inspector General audits found. 
  2. 5 employer insurance trends to watch in 2024

    Employers will be expecting insurers and vendors to deliver more transparency and ways to cut healthcare spending in 2024, according to the Business Group on Health. 
  3. Optum's full-risk Medicare Advantage patients have better health outcomes than Medicare enrollees

    Optum patients who are enrolled in fully accountable Medicare Advantage plans — where Optum takes full financial and clinical responsibility — have better health outcomes than patients enrolled in traditional Medicare, according to UnitedHealthcare CEO Brian Thompson.

A new framework for measuring RCM success — Insights from Denver Health

RCM optimization isn't cheap — but what hospitals really can't afford is sticking to the status quo. Discover how this safety-net hospital is advancing digital transformation in RCM here.
  1. HCSC eyeing Cigna's Medicare Advantage business: Report

    The sale of Cigna's Medicare Advantage business would remove one hurdle in the company's reported goal to merge with Humana, and Health Care Service Corp. might be part of that equation, Bloomberg reported Nov. 29. 
  2. 18 top execs that have recently left Optum

    In 2023, 18 top executives previously with UnitedHealth Group's Optum have announced retirement or new positions with companies across the country.
  3. 14 top execs that have recently left UnitedHealth Group

    From regional CEOs to its chief growth officer, these are 14 top executives that have recently departed from UnitedHealth Group and its subsidiaries.
  4. Highmark Blue Shield names SVP of corporate affairs 

    Highmark Blue Shield has named Ken Lawrence as senior vice president of corporate affairs for southeastern Pennsylvania as the company expands its health plans into the Philadelphia area next year. 

5 signs it's time for end-to-end RCM

There are 5 signs that it's time to switch to end-to-end RCM. Learn what they are + solutions here.
  1. UnitedHealth received 3.9M job applications in 2023

    Nearly 4 million people applied to work at UnitedHealth Group in 2023, CEO Andrew Witty said. 
  2. Former UnitedHealthcare, Optum executive joins Scene Health

    Former UnitedHealthcare and Optum executive William Teague has joined medication engagement company Scene Health as vice president of population health and health plan strategy. 
  3. Why BCBS Arizona wants to look more like Kaiser 

    Blue Cross Blue Shield of Arizona is looking to the payer-provider example set by Kaiser Permanente as the Phoenix-based company expands its primary care subsidiary Prosano Health Solutions, the Phoenix Business Journal reported Nov. 20.
  4. BCBS Michigan reaches tentative deal with workers after 11-week strike

    Blue Cross Blue Shield of Michigan has reached a tentative agreement with over 1,000 employees on strike. 

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. Cigna, Humana 'in talks' to merge

    The Cigna Group and Humana are "in talks" to merge, The Wall Street Journal reported Nov. 29.
  2. UnitedHealth's 5 growth priorities

    UnitedHealth Group outlined its five strategic growth priorities at its annual investor conference Nov. 29: 
  3. UnitedHealth Group projects $400B in 2024 revenue

    UnitedHealth Group expects 2024 revenues to be at least $400 billion. 
  4. Anthem, Wellstar agree to 4-year contract

    Anthem Blue Cross and Blue Shield of Georgia and Marietta, Ga.-based Wellstar Health System have agreed to a new contract that will keep Wellstar patients in network with the payer through May 2027. 
  5. UnitedHealthcare updates home health prior authorization review process

    UnitedHealthcare is updating its prior authorization and concurrent review process for home health services that are delegated to Home & Community Care, the payer's home care division. 
  6. 20% of ACA marketplace enrollees are new to program: HHS

    About 4.6 million people have signed up for health insurance through ACA marketplaces as of Nov. 18. 
  7. UnitedHealth, Cigna face lawsuits over alleged automated claims denials

    UnitedHealthcare and Cigna Healthcare are facing lawsuits from members or their families alleging the organizations use automated data tools to wrongfully deny members' medical claims. The allegations come amid broader ongoing conversations among policymakers around insurers' use of algorithms and artificial intelligence when processing claims or prior authorization requests.
  8. Bipartisan anger over Medicare Advantage denials on the rise

    Concerns about Medicare Advantage denials are on the rise in Washington, Politico reported Nov. 24. 
  9. BCBS Association taps CareFirst CEO as board chair 

    The Blue Cross Blue Shield Association's board of directors has elected CareFirst BlueCross BlueShield President and CEO Brian Pieninck as chair, effective Nov. 15.

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