Today's Top 20 Stories
  1. Common procedures can double in cost when performed at an HOPD vs. ASC, BCBS data shows

    Common medical procedures can cost more than twice as much when they take place in a hospital outpatient setting compared to a physician office or ambulatory surgery center, according to an analysis published Sept. 14 by the Blue Cross Blue Shield Association.
  2. Advice from one of BCBS' longest-serving CEOs

    Mike Murphy, one of the longest-serving Blue Cross Blue Shield CEOs, says relationships with providers have not worsened over his 16 years at the helm of Anthem BCBS Nevada — they've just grown more complicated. 
  3. CVS Health 'optimistic' its Medicare Advantage star ratings will improve

    CVS Health CEO Karen Lynch said she is "optimistic" Aetna will improve its Medicare Advantage star ratings for 2024. 

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. Value-based care is saving payers billions: 4 programs to know

    Some payers are reporting big savings with value-based care efforts. 
  2. Payers sue to block executive moves

    There is a small pool of executive candidates who can oversee millions of lives and produce positive financial results for large healthcare organizations, and payers have shown they are willing to take those executives to court when they leave for new opportunities.
  3. Oregon health system terminates contract with UnitedHealthcare

    Corvallis, Ore.-based Samaritan Health Services has terminated its commercial and Medicare Advantage contracts with UnitedHealthcare.
  4. CVS Health unconcerned about changes to Blue Shield of California PBM contract

    Reactions to Blue Shield of California's decision to drop its contract with CVS Caremark to manage pharmacy benefits in favor of a partnership with five companies have been overblown, CVS Health CEO Karen Lynch said. 

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. Civil rights groups file federal discrimination complaint against Florida over Medicaid redeterminations

    The nation's largest Latino civil rights organization, UnidosUS, along with 12 other state and national organizations, have filed a complaint with the HHS Office of Civil Rights regarding what they say is Florida's "illegal discrimination" under the Civil Rights Act against families and children of color amid the state's Medicaid redetermination process.
  2. 1,000 BCBS Michigan employees strike

    Over 1,000 Blue Cross Blue Shield of Michigan employees are striking, after United Auto Workers and the company failed to reach a new contract agreement. 
  3. 26% of employers plan to offer weight loss drug benefits over next year: Survey

    Weight loss drugs like Ozempic and other GLP-1s exploded in popularity this year, resulting in drug shortages and increasing costs for payers and employers. 
  4. Meet CVS Health's leadership team

    CVS Health recently expanded the roles of three of its C-suite executives and welcomed a new president of Aetna. Here is more information about executives that make up CVS Health's leadership team, according to the company's website:  

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. Medicaid coverage helped lower uninsured population in 2022 as poverty level soared

    Additional Medicaid coverage enacted during the COVID-19 pandemic helped keep the number of uninsured people down at record lows in 2022 even as poverty levels soared, according to a Sept. 12 New York Times report.
  2. 5 prior authorization updates

    From payers announcing cuts, to a lawmaker investigation denials, here are five updates about prior authorizations Becker's reported since Aug. 17: 
  3. Texas awards 7 payers new contracts to manage Medicaid long-term services

    Seven payers, including UnitedHealthcare, Molina Healthcare and Centene subsidiary SuperiorHealth Plan, were awarded contracts to manage Texas' STAR +PLUS program, which provides Medicaid to adults with disabilities or are 65 years of age and older. 
  4. Will Mississippi move on Medicaid expansion in 2024?

    Mississippi could consider Medicaid expansion next year, Mississippi Rep. Jason White told Mississippi Today. 
  5. Many older adults overwhelmed by too many Medicare options: Survey

    The majority of older adults say they would stick with their current Medicare plan rather than switch to a different plan when they feel they have too many options, a survey from the Commonwealth Fund found. 
  6. Top Medicare supplement plans of 2023, per Forbes 

    Humana offers the best Medicare supplement plan in 2023, according to a ranking published Sept. 7 by Forbes Health.
  7. Major payers drop senior companionship company following patient abuse allegations 

    Humana, Aetna and Molina are not renewing their contracts with senior companionship company Papa following allegations of abuse against patients or company employees, Bloomberg reported Sept. 11.
  8. Empire BCBS, Catholic Health ink value-based contract 

    Empire BlueCross BlueShield and Rockville Centre, N.Y.-based Catholic Health have partnered on a multi-year value-based payment and care delivery model.
  9. Elevance Health sues to block former Medicare executive from joining Molina

    Elevance Health is seeking to block a former regional Medicare president from taking a similar role at Molina Healthcare, alleging the former executive is in possession of trade secrets that would inevitably be disclosed to Molina. 

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