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CalOptima Health, the public Medi-Cal insurer for Orange County, Calif., will soon begin selling individual plans on the state’s ACA…
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Behavioral health utilization rose 62.6 percent between 2018 and 2024 and the national mental health workforce is on pace to fall nearly 100,000 full-time counselors short of demand by 2038. Emergency departments are absorbing much of that strain: hospitals reporting…
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- Sara Gotheridge, MD, Chief Medical Officer, Array
AI chiefs have become increasingly present in health systems, shaping governance, implementation and oversight. Health plans and their subsidiaries have been getting on the bandwagon, too. While analytics- and technology-centric executives are often responsible for AI initiatives at companies, some…
Basing Medicaid drug prices on what other wealthy countries pay could save 47 states and the District of Columbia a combined $8.6 billion — about 35% of net spending on the drugs studied — according to research published July 15…
The Maryland Department of Health did not audit pharmacy claims for three of its four fee-for-service pharmacy programs, leaving approximately $674.5 million in fiscal 2025 claims without routine reviews for fraud, waste, abuse and billing violations, according to a July…
A federal judge has paused eight provisions of CMS’ 2027 ACA marketplace rule, blocking a slate of eligibility, verification and plan design changes just days before they were set to take effect July 20. Judge Brendan Hurson of the U.S.…
A newly proposed federal bill would create a government-run public health insurance option sold on the ACA exchanges and permanently extend the enhanced premium subsidies that lapsed at the end of 2025. The Medicare-X Choice Act, introduced July 15 by…
Nearly half of U.S. hospitals now offer remote patient monitoring (RPM) services. The next challenge is turning those programs into better chronic disease management, stronger patient engagement and measurable outcomes. In fact, the Centers for Medicare and Medicaid Services (CMS)…
Presented by:
- Lucienne Ide, MD, PhD, Chief Medical Officer, Health Recovery Solutions
- Lindsey Valenzuela, PharmD, APh, BCACP, VP Population Health Integration, Desert Oasis Healthcare
Synthetic identity fraud and deepfake-enabled attacks are active, scaled, and accelerating. Most organizations haven’t caught up. The verification methods many healthcare providers rely on were built around a simpler threat: one document, one face, one check. Today’s fraudsters combine AI-generated…
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UnitedHealth Group still expects a Medicare Advantage enrollment loss for 2026, but the company lowered its projection on a July 16 earnings call. During the company’s fourth-quarter and full-year 2025 earnings call in January, UnitedHealthcare CEO Tim Noel said he…
The constant buzz around AI has left many healthcare payer executives fatigued. The hype is loud, the path to value isn’t clear and it’s tempting to wait for the noise to settle. But waiting has a cost. The gap between…
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