Today's Top 20 Stories

  1. Terminated BCBS Tennessee employees file class action over COVID vaccine mandate 

    Jakob Emerson -
    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

    Rylee Wilson -
    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

    Rylee Wilson -
    A judge denied Prisma Health's request for a temporary restraining order preventing UnitedHealthcare from disclosing details about contract negotiations to the press. 

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  1. Amerigroup New Jersey names president

    Andrew Cass -
    Elevance Health subsidiary Amerigroup New Jersey has named Patrick Fox, MD, president.

  2. What 3 payers have said about their prior authorization cuts

    Andrew Cass -
    As prior authorizations have come under the regulatory and legislative microscope, several payers have announced cuts to their requirements. 

  3. AHIP taps interim CEO

    Jakob Emerson -
    AHIP has named its general counsel, Julie Simon Miller, to serve as interim CEO, effective Oct. 2.

  4. Florida Blue-Aledade ACO reports $14M in savings, improved patient outcomes

    Jakob Emerson -
    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.

5 signs it's time for end-to-end RCM

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  1. Highmark's value-based primary care program tops $3B in savings 

    Jakob Emerson -
    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.

  2. Medicare Advantage enrollment on the rise in rural areas

    Rylee Wilson -
    Medicare Advantage enrollment is growing faster in rural and micropolitan areas than in metropolitan areas, according to an analysis from KFF published Sept. 7. 

  3. Self-funded plans have little leverage to negotiate with providers: Study

    Rylee Wilson -
    Employers that self-fund their employees' insurance pay moderately more for several medical services than fully funded plans, a study published in the September issue of Health Affairs found. 

  4. Humana in the headlines: 9 recent updates

    Rylee Wilson -
    Humana filed a challenge to CMS' Medicare Advantage clawback rule and said it plans to expand into in-home primary care. 

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  1. ACA exchange enrollment reaches record high of 15.7 million

    Rylee Wilson -
    ACA exchange enrollment reached a record high in early 2023, and the individual market reached an almost record size, according to an analysis from KFF published Sept. 7. 

  2. More people are switching from traditional Medicare to Medicare Advantage, HHS finds

    Rylee Wilson -
    Most growth in Medicare Advantage enrollment since 2006 was driven by people switching from fee-for-service Medicare to the program, a study by HHS researchers published in the September issue of Health Affairs found. 

  3. BCBS Michigan to cut 20% of prior authorization requirements

    Andrew Cass -
    Blue Cross Blue Shield of Michigan is the latest payer to announce it is scaling back its prior authorization requirements.

  4. Meet Oscar Health's leadership team

    Andrew Cass -
    Oscar Health has named two more Aetna veterans to its executive leadership, joining former Aetna CEO Mark Bertolini, who joined the company earlier this year.    

  5. 5 recent payer lawsuits, settlements

    Andrew Cass -
    From Humana suing HHS over a new Medicare Advantage clawback rule, to Prisma Health accusing UnitedHealthcare of breaching a confidentiality agreement, here are five lawsuits and settlements involving payers Becker's has reported since Aug. 16.  

  6. Alignment Health taps chief medical officer

    Jakob Emerson -
    Alignment Healthcare has named Hyong (Ken) Kim, MD, as its chief medical officer, effective Sept. 25.

  7. Fewer large employers opting for self-funded insurance

    Rylee Wilson -
    The number of large employers choosing self-pay over fully-insured benefits has declined since 2010, according to a brief from the Employee Benefits Research Institute published Aug. 24. 

  8. Here's where Medicare Advantage and traditional Medicare differ the most on spending

    Rylee Wilson -
    Medicare Advantage plans generally spend less per enrollee than traditional Medicare plans, but these differences vary widely by condition, a study published in the September issue of Health Affairs found. 

  9. The mystery behind Medicare's slowed spending

    Rylee Wilson -
    Medicare spending per beneficiary has remained stagnant over the past decade, but the reasons why are unclear, The New York Times reported  Sept. 4. 

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