Today's Top 20 Stories
  1. Optum sells Settlement Solutions business

    Optum has sold its workers' compensation Settlement Solutions business to ExamWorks Compliance Solutions, an Optum spokesperson told Becker's June 10.
  2. 5 recent payer investments in affordable housing

    Insurers are investing billions into affordable housing as they look to address healthcare challenges stemming from housing instability.
  3. Payers are missing major AI opportunities: McKinsey

    Artificial intelligence has the potential to lower internal and member costs for insurers while also increasing profits, but the industry has largely not embraced these opportunities, according to a June 5 analysis from McKinsey.

The state of AI in healthcare

86% of healthcare leaders say AI will define success over the next 5 years. Insights + strategies for successful adoption here.
  1. Former UnitedHealth Group exec joins VSP Vision

    VSP Vision has named former UnitedHealth Group executive Usha Patil as chief insurance officer. 
  2. UnitedHealthcare, Alabama's largest private health system split

    Mobile, Ala.-based Infirmary Health is out of network with UnitedHealthcare as of June 4. 
  3. D-SNP prior auth denial rates twice as high as all Medicare Advantage

    Dual-eligible special needs plan enrollees are twice as likely to have prior authorization requests denied compared to all other Medicare Advantage members, according to KFF.
  4. California to repay $52M spent on Medicaid for noncitizens

    California improperly used $52.7 million in federal Medicaid funds to pay for nonemergency care for Medicaid recipients without legal status, according to an audit from HHS' Office of Inspector General. 

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. Where payers landed on the Fortune 500 | 2024

    Seven payers landed among the top 25 healthcare companies on the Fortune 500 in 2024. 
  2. Commercial payers estimate $1.1B for 2024 member rebates 

    Payers are expecting to issue a total of about $1.1 billion in medical loss ratio rebates across all commercial markets in 2024, according to preliminary estimates published June 5 by KFF.
  3. Aetna names VP, head of commercial regions

    Aetna has promoted Erich Twachtman to vice president, head of commercial regions. 
  4. Former Cigna exec still barred from taking CVS role

    A federal appeals court ruled that a lower court did not abuse its broad discretion by granting Cigna a request for a preliminary injunction barring a former executive from taking a job at CVS Health while a lawsuit over her noncompete clause moves forward. 

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. 10 providers seeking payer contracting talent

    Ten providers recently posted job listings seeking leaders in payer contracting and relations.
  2. BCBS Massachusetts expands access to LGBTQ services

    Blue Cross Blue Shield of Massachusetts is expanding access to LGBTQ-focused services for its members.
  3. A 'rough year' for payers' government programs

    The nation's largest health insurers have signaled significant headwinds in recent months across their Medicare Advantage and Medicaid businesses as costs rise and the effect of redeterminations takes hold.
  4. Remembering Bill Walton, the most joyful team player

    Bill Walton was one of the most interesting and dynamic people to influence sports and culture over the last 71 years. A basketball icon with a passion for The Grateful Dead, he engaged sports enthusiasts for nearly three decades with his vibrant commentary as a broadcaster.
  5. SCAN beats CMS in Medicare Advantage star ratings lawsuit

    SCAN Health Plan has won its lawsuit against CMS that claimed the agency improperly calculated the payer's 2024 Medicare Advantage star rating.
  6. Pharma exec charged with cyberstalking Aetna leaders

    A former AstraZeneca executive is facing federal cyberstalking charges for allegedly sending violent threats to executives at CVS Health and Aetna following issues with personal claims reimbursements, according to a criminal complaint filed May 8 in a Delaware federal court.
  7. UnitedHealth, Amedisys divestiture deal stalls: Report

    A possible divestiture buyer has backed out of a deal with UnitedHealth Group and Amedisys that aimed to make a proposed acquisition of the home health company more palatable to regulators, the Capitol Forum reported May 31.
  8. Cigna to lay off 261 in Arizona

    Cigna's Evernorth Care Group plans to cut specific specialty services and consolidate certain Arizona care locations in the next few months. The reductions will result in 261 employees being laid off, according to an Arizona WARN notice filed May 31. 
  9. BCBS Kansas City exiting Medicare Advantage market

    Blue Cross and Blue Shield of Kansas City is exiting the Medicare Advantage market at the end of 2024, citing increasing regulatory requirements and financial headwinds. 

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