Today's Top 20 Stories
  1. Why the ACA health insurance exchange is the next reimbursement battle ground

    There are now more than 20 million Americans enrolled through the individual health insurance exchange marketplace (HIX) and growing. A product originally designed to provide coverage for the uninsured and those caught between having too much to qualify for Medicaid, but not quite enough to afford commercial coverage, is now setting its sights on the small group commercial market through ICHRA, or an individual coverage health reimbursement arrangement. This has the potential to be incredibly disruptive to providers given the negative impact this shift could have on overall reimbursement and provider margins.
  2. The five non-negotiable traits of an exceptional medical benefits management partner

    When it comes to medical benefits management, finding the right partner is crucial. Safeguarding and improving members’ health while effectively supporting providers is paramount to a successful strategy. An exceptional partner should align with your goals and embody five key traits.
  3. California lawmakers trying again for single-payer

    California lawmakers have introduced legislation again that would provide "comprehensive universal single-payer" health coverage for all 39 million residents of the state under a program called CalCare.

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. Molina Healthcare eyes more M&A

    More mergers and acquisitions are a key part of Molina Healthcare's future strategy, executives told investors. 
  2. Centene: States slow to pick up Medicaid weight-loss drug coverage

    Few states are adding coverage of GLP-1 drugs for weight loss, Centene executives said. 
  3. Aetna, Dignity Health strike deal

    Aetna and San Francisco-based Dignity Health have reached an agreement on a multiyear contract that allows the payer's members to remain in network with Dignity's facilities and providers in California, Arizona and Nevada.   
  4. Centene posts $1.2B profit in Q1

    Centene reported nearly $1.2 billion in net income in the first quarter and a more than 18% decrease in Medicaid membership year over year, according to its first-quarter earnings posted April 26.

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. How the payer workforce will evolve, per 12 executives

    Payer executives anticipate building their equity and population management teams and leaning on AI and new technology in the coming years. 
  2. 7 things to know about UnitedHealth Group's CEO

    UnitedHealth Group CEO Andrew Witty is set to testify May 1 before a U.S. House subcommittee about the Feb. 21 cyberattack on the company's Change Healthcare subsidiary. 
  3. Highest-paid payer CFOs in 2023

    UnitedHealth Group CFO John Rex was the highest-paid CFO of a major insurer in 2023. 
  4. Cigna sets quarterly dividend

    The Cigna Group's board authorized the company to pay a cash dividend of $1.40 to be paid on June 20. 

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. Payers ranked by total workforce

    The nation's largest health insurers collectively employ around 850,000 people in the U.S.
  2. Humana expands partnership with prior authorization platform

    Humana is expanding its use of Cohere's prior authorization platform for diagnostic imaging and sleep services. 
  3. 25 payers among Forbes' best employers for diversity 

    25 payers have been included on Forbes' seventh annual ranking of the nation's best employers for diversity. 
  4. Humana plans to leave some Medicare Advantage markets in 2025

    Humana expects to exit Medicare Advantage markets in 2025, company executives told investors. 
  5. Humana posts $741M profit in Q1

    Humana reported $741 million in net income in the first quarter of 2024. 
  6. California hospitals sue Anthem Blue Cross over discharge delays

    The California Hospital Association is alleging Anthem Blue Cross of California violated the state's patient safety laws by failing to facilitate members' transfer to post-acute care. 
  7. Payers ranked by CEO-to-worker pay ratios

    Health insurance leaders were paid up to 392 times more than their respective median employee in 2023, according to recently filed proxy statements with the Securities and Exchange Commission.
  8. BCBS Minnesota names Optum's chief technology officer as CIO

    Blue Cross and Blue Shield of Minnesota has named Melissa Flicek as Chief Information Officer. 
  9. Highest-paid payer CEOs in 2023

    UnitedHealth Group's CEO was the highest paid out of major payer CEOs in 2023. 

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