Today's Top 20 Stories
  1. Hawaii pausing Medicaid terminations in wake of wildfires

    Hawaii is pausing Medicaid disenrollments for all Hawaii residents for the remainder of 2023 in the wake of the Maui wildfires. 
  2. Medicaid spending on Ozempic, other GLP-1 drugs, topped $1B in 2022

    Medicaid spent $1.1 billion on Ozempic and other GLP-1 drugs that can be used for weight loss in 2022, a KFF analysis published Sept. 8 found. 
  3. What 8 recent studies found about Medicare Advantage

    Much of Medicare Advantage growth is driven by people switching to the program from traditional Medicare, and this growth is picking up speed in rural areas. 

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. 26 payer executives' advice for future industry leaders

    Future leaders in the health insurance industry should stay curious, keep an eye toward the future and put members first, executives say. 
  2. Optum-Amedisys deal receives shareholder approval

    In an overwhelming majority, Amedisys shareholders approved a $3.3 billion acquisition by UnitedHealth Group's Optum on Sept. 8.
  3. Medicaid disenrollment rates by state

    The Medicaid disenrollment rate for reporting states as of Sept. 8 ranges from 72 percent in Texas to 9 percent in Michigan, according to KFF. 
  4. L.A. Care Health Plan to pay $1.3M to settle alleged HIPAA violations

    L.A. Care Health Plan has agreed to pay a $1.3 million settlement and to implement a corrective action plan to resolve allegations that it violated HIPAA regulations.

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. Medicare Advantage in the headlines: 9 recent updates

    Humana is challenging a rule from CMS that could leave insurers on the hook for billions in repayments, and new HHS research reveals most growth in the program is fueled by people switching from traditional Medicare. 
  2. 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. 
  3. 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.
  4. 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.

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. 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. 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. 
  6. AHIP taps interim CEO

    AHIP has named its general counsel, Julie Simon Miller, to serve as interim CEO, effective Oct. 2.
  7. 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.
  8. 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.
  9. 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. 

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