Today's Top 20 Stories
  1. 22 million people could lose cost-free mammograms under preventive care court ruling: Report

    Over 20 million women between the ages of 50 and 64 could lose access to cost-free mammograms if a court ruling striking down requirements for payers to cover preventive care at no cost is upheld, according to a report from the Robert Wood Johnson foundation. 
  2. Friday Health Plans pauses Colorado enrollments

    Friday Health Plans will not accept new health plan enrollments in Colorado for the remainder of 2023 after an agreement was reached with the Colorado Division of Insurance. 
  3. Virginia Premier Medicaid members shifting to Optima Health

    Virginia Premier will move its 300,000 Medicaid members to Optima Health on July 1.

Target the full spectrum of cardiometabolic conditions for better member outcomes, plan savings

Only 2.7% of US adults live a healthy lifestyle — & that costs health plans $500B a year. This approach supports better outcomes + employer savings.
  1. HealthPartners names senior vice president for health solutions

    HealthPartners has named Megan Schmidt senior vice president of health solutions. 
  2. $14M Centene office space up for sale

    An office building Centene invested millions in but rarely used is up for sale, the St. Louis Business Journal reported May 9. 
  3. Minnesota fines HealthPartners for mental health parity violations

    The Minnesota Department of Commerce alleges that HealthPartners violated mental health parity laws by analyzing claims for mental health and substance abuse treatment more stringently than other types of care. 
  4. AHIP: Best practices for Medicaid redeterminations

    Best practices for state Medicaid programs during the unwinding of continuous coverage requirements include strong communications, a bolstered workforce and transparent data, according to AHIP. 

3 ways to address No Surprises Act compliance challenges

A no-surprises approach to the No Surprises Act — get 3 strategies to improve compliance here.
  1. Oscar Health posts $39.6M loss in Q1

    Oscar Health improved its year-over-year losses in the first three months of 2023. 
  2. Baton Rouge General strikes deal with Cigna, but Aetna impasse remains

    Baton Rouge (La.) General has reached an agreement on a new contract with Cigna but remains out of network with Aetna, The Advocate reported May 9. 
  3. Oscar Health to exit California market in 2024

    Oscar Health will exit the California individual ACA insurance market for plan year 2024 as part of a push to make its insurance business profitable. 
  4. 8 prior authorization updates

    From Google Cloud launching an artificial intelligence-powered claims acceleration suite to CMS issuing a final rule to streaming the Medicare Advantage prior authorization process, here are eight prior authorization updates Becker's reported since April 6: 

Target the full spectrum of cardiometabolic conditions for better member outcomes, plan savings

Only 2.7% of US adults live a healthy lifestyle — & that costs health plans $500B a year. This approach supports better outcomes + employer savings.
  1. Former UnitedHealth VP tapped for Athenahealth C-suite role

    EHR vendor Athenahealth named George Hamilton chief corporate strategy and development officer. 
  2. Gold Kidney Health Plan names former UnitedHealthcare plan exec as COO

    Gold Kidney Health Plan, a payer offering Medicare Advantage special needs plans, has named Gregg Kunemund as chief operating officer. 
  3. In Chattanooga, former payer campuses could become schools, housing

    Government officials want to turn an 11-acre BlueCross BlueShield site for sale in Chattanooga, Tenn., into a public school campus. 
  4. 73,000 people lose Medicaid coverage in 1st month of Arkansas' redetermination speedrun

    Arkansas terminated Medicaid coverage for almost 73,000 people in April, including 44,667 people who had their eligibility extended during the COVID-19 public health emergency. 
  5. Bright Health posts $169M loss in Q1

    Bright Health Group improved on its losses year over year and upped revenue in the first quarter of 2023. 
  6. Medicare Advantage as a percentage of all Medicare enrollment, year by year

    Medicare Advantage enrollment now represents half of total Medicare enrollment, according to a May 1 analysis from the Kaiser Family Foundation. 
  7. Centene shareholder proposals zero in on executive pay

    Centene shareholders will vote on a pair of proposals that take aim at executive pay, the St. Louis Post-Dispatch reported May 9. 
  8. Centene beats COVID-19 reimbursement lawsuit

    A Connecticut medical practice's lawsuit alleging Centene failed to reimburse it for COVID-19 testing services has been thrown out after the practice missed a deadline to refile the case. 
  9. UnitedHealthcare, Northeast Georgia Health split amid contract impasse

    Gainesville-based Northeast Georgia Health System went out of network with UnitedHealthcare's employer-sponsored and individual plans after the two sides were unable to reach a new contract, UnitedHealthcare said in a May 1 news release. 

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