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Centene’s ‘Ohana Health Plan is leaving Hawaii’s Medicaid managed care program, QUEST, on Dec. 31, according to a Sept. 1…
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Mental health ghost networks reach well beyond public insurance programs. Directory errors affected 55.6% of evaluable secret shopper calls to psychiatrists and psychologists listed by the largest commercial carrier in each of five states, according to a study published Oct.…
UnitedHealth Group’s count of subsidiaries and related entities has reached 2,807, according to the latest “Sunlight Report,” published in October. The report comes from the Center for Health & Democracy and is funded by Arnold Ventures. The updated report identified…
Molecular residual disease (MRD) testing is moving into the next phase of precision oncology, extending molecular insight past diagnosis and treatment selection into post-treatment monitoring, surveillance and survivorship. For health systems, the question is not whether to add another test.…
Presented by:
- Rick Baehner, MD, Chief Medical Officer, Precision Oncology Abbott Cancer Diagnostics, Clinical Professor of Pathology,, University of California, San Francisco
CMS is pitching new guardrails for pharmacy benefit managers and Medicare Advantage plans under a proposed rule released Oct. 16. The proposed rule would implement sections of the Consolidated Appropriations Act of 2026. Comments are due Dec. 15. Here are…
Epic is working with Amazon Pharmacy, Mark Cuban Cost Plus Drugs and other pharmacy companies to develop a tool that will allow clinicians and patients to compare prescription drug prices directly within its EHR system. The new feature, called Prescription…
A top CMS official wants provider suspensions to quadruple in the next six months as the agency puts new exclusion authority to work and tests AI tools to catch fraud, Nextgov/FCW reported Oct. 15. CMS Deputy Administrator Kimberly Brandt discussed…
Value-based care promised better outcomes at lower cost. Years of effort and millions in infrastructure later, payer leaders are asking a blunt question: is it delivering? On Oct. 21, join us for a candid discussion built for payer leaders that…
Presented by:
- Tim Smith, ASA, MAAA, MS, Chief Actuary, Arbital Health
- Niall Brennan, Chief Data and Analytics Officer, Horizon BCBS
- Ali Khan, MD, MPP, FACP, Advisor, Andreessen Horowitz, Former CMO of Medicare, Aetna
Centene is expanding Custom Health Option and Individual Care Expense Arrangements, formerly known as individual coverage health reimbursement arrangements, to all of its Ohio and Oklahoma employees in plan year 2027. An Oct. 16 news release said the development builds…
The American Hospital Association has launched a website to help hospitals and health systems prepare for electronic prior authorization requirements that take effect Jan. 1, 2027. Major provisions of CMS’ 2024 Interoperability and Prior Authorization Final Rule begin on that…
A year after executives said Optum Health had drifted from its original value-based care model, the smaller business is producing much larger profits, according to UnitedHealth Group’s Oct. 13 earnings release and call. Optum Health’s earnings from operations rose to…
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