Today's Top 20 Stories
  1. Throw out the fax machine: Blue Shield of California's CEO on conquering healthcare's inertia

    Paul Markovich has spent more than two decades at Blue Shield of California, the past 10 as its president and CEO. 
  2. Top Medicare Part D plans of 2023, per Forbes 

    UnitedHealthcare offers the best Medicare Part D prescription drug plan in 2023, according to a ranking published Sept. 8 by Forbes Health.
  3. Health system-payer negotiations go awry

    Contract negotiations between health systems and insurers are a common occurrence across healthcare, but every so often talks disintegrate and disputes make their way into the public eye.

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. Terminated BCBS Tennessee employees file class action over COVID vaccine mandate 

    Former employees with BlueCross BlueShield of Tennessee say their religious rights were violated by the payer after they were terminated for refusing to be vaccinated against COVID-19, according to a class action lawsuit filed Sept. 7 in a Tennessee federal court.
  2. National gym chain to limit hours for Medicare members

    Life Time, a gym chain with over 150 locations nationwide, will limit the hours members who receive their memberships through Medicare benefits can use the fitness clubs. 
  3. Judge denies Prisma Health's request for temporary restraining order against UnitedHealthcare

    A judge denied Prisma Health's request for a temporary restraining order preventing UnitedHealthcare from disclosing details about contract negotiations to the press. 
  4. Amerigroup New Jersey names president

    Elevance Health subsidiary Amerigroup New Jersey has named Patrick Fox, MD, president.

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. What 3 payers have said about their prior authorization cuts

    As prior authorizations have come under the regulatory and legislative microscope, several payers have announced cuts to their requirements. 
  2. AHIP taps interim CEO

    AHIP has named its general counsel, Julie Simon Miller, to serve as interim CEO, effective Oct. 2.
  3. Florida Blue-Aledade ACO reports $14M in savings, improved patient outcomes

    Aledade, a network of independent primary care providers, and Florida Blue's ACO has resulted in millions in shared savings for participating providers and improved health outcomes for 41,000 members in the program's first two years.
  4. Highmark's value-based primary care program tops $3B in savings 

    Highmark's value-based reimbursement program for primary care physicians, True Performance, has saved more than $3 billion in avoided cost savings in Pennsylvania, Delaware and West Virginia since its launch in 2017.

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. Medicare Advantage enrollment on the rise in rural areas

    Medicare Advantage enrollment is growing faster in rural and micropolitan areas than in metropolitan areas, according to an analysis from KFF published Sept. 7. 
  2. Self-funded plans have little leverage to negotiate with providers: Study

    Employers that self-fund their employees' insurance pay moderately more for several medical services than fully funded plans, a study published in the September issue of Health Affairs found. 
  3. Humana in the headlines: 9 recent updates

    Humana filed a challenge to CMS' Medicare Advantage clawback rule and said it plans to expand into in-home primary care. 
  4. ACA exchange enrollment reaches record high of 15.7 million

    ACA exchange enrollment reached a record high in early 2023, and the individual market reached an almost record size, according to an analysis from KFF published Sept. 7. 
  5. More people are switching from traditional Medicare to Medicare Advantage, HHS finds

    Most growth in Medicare Advantage enrollment since 2006 was driven by people switching from fee-for-service Medicare to the program, a study by HHS researchers published in the September issue of Health Affairs found. 
  6. BCBS Michigan to cut 20% of prior authorization requirements

    Blue Cross Blue Shield of Michigan is the latest payer to announce it is scaling back its prior authorization requirements.
  7. Meet Oscar Health's leadership team

    Oscar Health has named two more Aetna veterans to its executive leadership, joining former Aetna CEO Mark Bertolini, who joined the company earlier this year.    
  8. 5 recent payer lawsuits, settlements

    From Humana suing HHS over a new Medicare Advantage clawback rule, to Prisma Health accusing UnitedHealthcare of breaching a confidentiality agreement, here are five lawsuits and settlements involving payers Becker's has reported since Aug. 16.  
  9. Alignment Health taps chief medical officer

    Alignment Healthcare has named Hyong (Ken) Kim, MD, as its chief medical officer, effective Sept. 25.

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