Today's Top 20 Stories
  1. CMS publishes new guidance on Medicaid, CHIP coverage: 7 things to know

    CMS is providing states new guidance to ensure states comply with required Medicaid services for children. 
  2. OIG audits Humana, Aetna for Medicare Advantage overpayments: 10 things to know

    Subsidiaries of Aetna and Humana received millions in Medicare Advantage overpayments in 2017 and 2018, the HHS Office of Inspector General alleged in audits published Sept. 25. 
  3. 16 payer headwinds to know 

    Payer executives are keeping a close eye on a shifting regulatory environment and ongoing provider shortages. 

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  1. Startup Medicare Advantage plan gets $140M

    Startup Medicare Advantage plan Zing Health has raised $140 million in funding. 
  2. Health systems back Centivo in $75M financing round

    Centivo, a Buffalo, N.Y.-based health plan administrator for self-insured employers, has secured $75 million in equity and debt financing.
  3. 10 providers seeking payer contracting talent

    Ten providers recently posted job listings seeking leaders in payer contracting and relations.
  4. The biggest barrier to value-based success, per 1 exec

    Resistance to change is the biggest barrier to value-based care, Monica Engel, senior vice president of Government Markets at Blue Cross Blue Shield of Minnesota, told Becker's. 

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  1. The lowest-rated health plans of 2024: NCQA

    Of the 1,019 health plans rated by the NCQA in 2024, 13 received a rating of 2 stars or lower. 
  2. How a 5-star Medicare Advantage plan approaches growth

    Medicare Advantage plans "lacking substance" will not stand the test of time, Jordan Reigel, president of Essence Healthcare, told Becker's. 
  3. CMS: States have 2 years to fix Medicaid renewal problems

    States must be in full compliance with all of CMS' Medicaid renewal requirements by the end of 2026.  
  4. UnitedHealthcare to add school-based mental health support in 14 states

    UnitedHealthcare will provide mental healthcare to 1 million children in schools through a partnership with Hazel Health. 

How one Midwest hospital is driving financial efficiency with interconnected systems

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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. The top GLP-1 challenge facing UPMC's health plan

    Insurers, health systems, state health plans and self-funded employers are all grappling with how to cover the high cost of GLP-1 medications, with some large organizations limiting coverage or dropping benefits entirely in 2024.
  2. States with largest Medicaid enrollment declines

    With Medicaid redeterminations complete in most states, Medicaid enrollment has decreased by 14.3% from March 2023, according to KFF. 
  3. CVS Health sets quarterly dividend

    CVS Health's board of directors approved a $0.665 per-share dividend to be paid Nov. 1. 
  4. The best-rated commercial health plans in each state: NCQA

    Three commercial plans received five-star ratings from the National Committee for Quality Assurance. 
  5. How CareFirst guides AI startups

    Healthworx, CareFirst Blue Cross Blue Shield's investment arm, aims to bridge the gap between an established insurer and scrappy startups, Managing Partner Doba Parushev said. 
  6. Former payer exec: Older adults should avoid Medicare Advantage in 2025

    During the upcoming annual enrollment period, seniors should opt for traditional Medicare over Medicare Advantage, according to seasoned healthcare executive Stacy Mays.
  7. Cigna to trim Medicare Advantage offerings in 8 states 

    Cigna Healthcare is exiting Medicare Advantage markets or making service area reductions in eight states for 2025, according to a Sept. 18 post from insurance brokerage firm Pinnacle Financial Services.
  8. States ranked by average monthly ACA subsidy per enrollee 

    West Virginia residents who receive health coverage on the ACA exchange receive the largest premium subsidies on average, while Minnesota residents receive the least, according to an analysis from KFF.
  9. Vance: Trump would make changes to ACA risk pools

    Deregulating the individual insurance market would be part of former President Donald Trump's healthcare agenda in a second term, according to his running mate, Sen. JD Vance.

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