Today's Top 20 Stories
  1. CVS improves Medicare Advantage star ratings, Elevance sees drop

    CVS Health delivered on its claims that its Medicare Advantage star ratings would improve for 2024. 
  2. Former BCBS CEO: Health plans should consider medical marijuana coverage

    Payers could soon face pressure to reconsider medical marijuana coverage policies following HHS' recommendation in August that the Drug Enforcement Administration reschedule the drug to a substance accessible through a prescription under federal law.
  3. Physician indicted for alleged fraud against Aetna, Premera

    An Alaska grand jury has indicted a physician and three clinic managers on felony charges over alleged billing fraud against the state's Medicaid program, Aetna and Premera BCBS of Alaska, Alaska Public Media reported Oct. 13.

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. UnitedHealth projects 1 million new Medicare Advantage, commercial members for 2024

    UnitedHealth Group expects to add around 1 million Medicare Advantage and commercial members by the end of 2023. 
  2. 10 top execs that have recently left Elevance Health

    From the CFO of its government business division to the COO of Carelon, these are 10 executive departures from Elevance Health and its subsidiaries over the last year:
  3. 31 5-star Medicare Advantage plans | 2024

    CMS gave 31 Medicare Advantage five-star ratings for 2024, the highest rating for quality and member satisfaction awarded by the agency. 
  4. Blue Shield of California taps chief medical officer for Medicaid plan

    Blue Shield of California has named Jennifer Nuovo, MD, as chief medical officer for its Promise Health Plan, which provides health coverage to Medi-Cal beneficiaries in Los Angeles and San Diego counties.

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. 2 C-suite leaders depart Centene after months on the job

    Centene's chief technology and transformation officer, along with its chief customer experience officer, have departed from the company after less than a year in their positions.
  2. Fewer Medicare Advantage plans snag 5-star ratings for 2024

    CMS' overall average star ratings declined slightly for Medicare Advantage plans for plan year 2024. 
  3. UnitedHealth wants to make weight loss drugs cheaper

    UnitedHealth Group wants to lower the price of GLP-1 drugs such as Ozempic and Wegovy, but it needs drug manufacturers to get on board, executives said. 
  4. What's new for Medicare open enrollment in 2023: 5 notes

    Medicare open enrollment begins Oct. 15 and runs through Dec. 7. During this time, enrollees can make changes to their Medicare coverage for the upcoming year, such as switching between Medicare Advantage plans, switching from MA to traditional Medicare and choosing new supplemental coverage. 

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. UnitedHealth Group posts $5.8B profit in Q3 

    UnitedHealth Group recorded double-digit growth in revenue year over year across its core lines of business at UnitedHealthcare and Optum, according to the company's third-quarter earnings report released Oct. 13.
  2. Medicare premiums to increase in 2024

    Medicare part B premiums and deductibles will increase slightly in 2024. 
  3. HealthPartners names chief medical officer for health plan

    HealthPartners has named Ginger Kakacek, MD, as chief medical officer for its health plan. 
  4. Medicaid in the headlines: 10 recent updates

    Medicaid redeterminations continue, and one state, Arkansas, has finished the process. States are also seeking new Medicaid contractors and dropping others. 
  5. Oscar Health expanding to 165 new counties for 2024

    Oscar Health is expanding its market footprint and adding new plans for 2024. 
  6. Alignment Health opens new community center in Southern California

    Medicare Advantage company Alignment Health opened a new community center in Laguna Woods, California on Oct. 3. 
  7. Southern California payer puts $52M behind affordable housing 

    CalOptima Health, a Medicaid insurer in Orange County, Calif., is awarding $52.3 million in grants to 15 organizations for the creation of affordable and permanent supportive housing. 
  8. 5 things to know about Humana's next CEO

    Humana CEO Bruce Broussard will step down from his role after a decade in 2024, and Envision Healthcare CEO Jim Rechtin will be his successor, the company said Oct. 11. 
  9. MetroPlusHealth names chief marketing officer

    MetroPlusHealth has named Laura Santella-Saccone as chief marketing and brand officer. 

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