Today's Top 20 Stories

  1. Revolutionizing payment accuracy: The future of payment integrity

    Jeff Plante, President, Carelon Insights -
    The continued rising cost of healthcare is prompting many health plans to take a closer look at the value strong payment integrity programs can drive. 

  2. Aetna adds fertility coverage in 'landmark' change

    Rylee Wilson -
    Aetna will cover intrauterine insemination as a medical benefit for eligible plans, a move the insurer called a "landmark policy change." 

  3. Pennsylvania selects 5 payers for special Medicaid contracts

    Jakob Emerson -
    Pennsylvania has selected Aetna, UPMC Health Plan, Centene, AmeriHealth Caritas and Jefferson Health's Health Partners to administer its Community HealthChoices  program.

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  1. What happens when Medicare Advantage contracts are terminated?

    Rylee Wilson -
    Around 1 in 5 Medicare Advantage beneficiaries switch to traditional Medicare when their plans shut down, a study published Aug. 20 in JAMA Network Open found. 

  2. CareFirst, Johns Hopkins launch AI accelerator

    Rylee Wilson -
    CareFirst BlueCross BlueShield, Johns Hopkins University and Techstars will partner on an accelerator program to launch new healthcare-focused AI companies. 

  3. States ranked by Medicaid spending per enrollee

    Jakob Emerson -
    Washington, D.C. has the highest Medicaid spending per enrollee, while Tennessee has the lowest, according to an Aug. 16 report from KFF.

  4. UnitedHealth reportedly eyes Surgery Partners acquisition

    Rylee Wilson -
    UnitedHealth Group is among the potential buyers of ambulatory surgical center operator Surgery Partners, Bloomberg reported Aug. 23, citing sources close to the matter.

How one Midwest hospital is driving financial efficiency with interconnected systems

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  1. Direct contracting grows: 6 key numbers

    Jakob Emerson -
    As healthcare costs continue to rise, a growing number of employers are exploring alternative payment models such as direct contracting, where the employer contracts directly with a provider for employee care.

  2. California provider directory reform bill dead

    Jakob Emerson -
    A California bill aimed at improving and enforcing the accuracy of insurer's provider directories has died in a state Senate committee.

  3. This Medicare Advantage plan says headwinds have 'very little impact'

    Rylee Wilson -
    Clover Health does not have direct competitors, CFO Peter Kuipers says. 

  4. What these payers learned through collaborating with their competitors

    Rylee Wilson -
    The largest payers in Washington state are working together to improve primary care. 

How one Midwest hospital is driving financial efficiency with interconnected systems

Sponsored
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. Alabama state health plan warns of funding shortfall

    Jakob Emerson -
    Alabama's state employee health plan is facing a projected loss of about $20 million in fiscal year 2025, the Alabama Reflector reported Aug. 22.

  2. BCBS Minnesota must face ERISA lawsuit from Labor Department, judge rules

    Jakob Emerson -
    A federal judge has ruled that Blue Cross and Blue Shield of Minnesota must face a lawsuit from the U.S. Labor Department accusing the payer of incorrectly imposing a state provider tax on self-funded health plan customers and violating its fiduciary duties under ERISA.

  3. Cigna names California market leader

    Rylee Wilson -
    Cigna Healthcare has promoted Marlene Matsuoka to general manager for its group employer business in Northern California. 

  4. Arizona upholds contract awards to UnitedHealth, Centene

    Rylee Wilson -
    Editor's note: This story was updated Sept. 12 to reflect that the Arizona Health Care Cost Containment Systems upheld its original contract awards.  Arizona will uphold contracts awarded to UnitedHealth and Centene to manage the state's long-term care Medicaid program. 

  5. Employers are worried about GLP-1s — most cover them anyway

    Rylee Wilson -
    Two-thirds of employers surveyed by the Business Group on Health cover GLP-1 drugs to treat obesity. 

  6. How Congress members get their health insurance

    Rylee Wilson -
    Members of Congress are tasked with making decisions about the future of the ACA exchange — and they also receive their healthcare benefits through it. 

  7. 17 payers cutting jobs | 2024

    Jakob Emerson -
    Payers are trimming their workforces and cutting jobs due to financial or operational challenges, along with restructuring strategies. 

  8. OIG: Elevance subsidiary received $59M in Medicare Advantage overpayments 

    Jakob Emerson -
    MMM Healthcare, a Puerto Rico subsidiary of Elevance Health, received $59 million in net Medicare Advantage overpayments for 2017, according to an audit from HHS' Office of Inspector General published Aug. 14.

  9. 10 states reforming prior authorization in 2024

    Andrew Cass -
    Ten states have passed laws reforming the prior authorization process, according to an Aug. 19 report from the American Medical Association. 

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