Today's Top 20 Stories
  1. UnitedHealthcare, Upstate University Hospital dispute could affect 20,000 patients

    About 20,000 patients could be left out of network if UnitedHealthcare and Syracuse, N.Y.-based SUNY Upstate University Hospital are unable to reach a new contract before the current one expires Dec. 31, syracuse.com reported Nov. 3. 
  2. Half of payers say they've had a data breach in the last 5 years

    Around half of payers had a data breach incident over the past five years, a report from LexisNexis Risk Solutions found. 
  3. How Kaiser Permanente built some of the nation's highest-quality health plans

    Kaiser Permanente's health plans often top lists for quality rankings. 

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  1. The 10 largest health insurers by commercial market share

    UnitedHealth Group was the largest health insurer by national-level market share in 2021, according to a Nov. 1 analysis from the American Medical Association. 
  2. 3 states taking on prior authorization reforms in 2022

    In late October, Pennsylvania state lawmakers sent a bill aiming to streamline the prior authorization process to the governor's desk, making it one of several states that have taken steps to reform that process this year. 
  3. 'The house always wins': Insurers' record profits clash with hospitals' hardship

    With most healthcare organizations having now released their third quarter earnings, the gap between provider and payer profits continues to widen.
  4. 10 states with least competitive commercial insurance markets

    Alabama has the most concentrated commercial health insurance market in the U.S., making it the state with the least competitive market, according to a Nov. 1 analysis from the American Medical Association. 

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  1. Cigna Q3 profits up 70%

    Cigna raised its annual earnings outlook and reported a 70 percent boost in third quarter profits compared to the same period last year, according to the company's earnings report published Nov. 3.
  2. Is Medicare Advantage defrauding the government? 7 experts weigh in

    Though Medicare Advantage was designed to help lower federal healthcare expenditures, recent reporting from The New York Times has thrust allegations of payers defrauding the government through the program back into the limelight.
  3. BCBS Minnesota sells home health subsidiary Livio Health

    Blue Cross Blue Shield of Minnesota is selling its home healthcare subsidiary, Livio Health, to senior health company Lifespark. 
  4. 78% of hospitals say their relationships with payers are getting worse

    Hospitals are growing increasingly frustrated with payers, a survey from the American Hospital Association found. 

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  1. UnitedHealthcare has 28% of Medicare Advantage market nationwide

    UnitedHealthcare has the largest share of the nation's Medicare Advantage market, according to a study from the American Medical Association. 
  2. Humana execs spending less time in Louisville in remote-work era, insiders say

    Humana's executives are less tied to the payer's Louisville, Ky., headquarters as the company shifts toward remote and hybrid work, WDRB reported. 
  3. Highmark, Allegheny Health to launch Cedar payer-provider billing platform

    Health insurer Highmark Inc. and associated healthcare system Allegheny Health Network, based in Pittsburgh, will be the first to launch a payer-provider patient billing platform from healthcare billing company Cedar.
  4. Blue Health Intelligence names former Prime Therapeutics exec Sam Mohanty chief technology officer

    Blue Health Intelligence, the Blue Cross Blue Shield Association's data analysis affiliate, appointed Sam Mohanty as chief technology officer. 
  5. Amerigroup Texas partners with tech developer to increase number of mental health providers

    Amerigroup Texas is partnering with Movito, a healthcare technology developer, to increase the number of mental health therapists in rural, remote and underserved areas. 
  6. Humana's $1.2B Q3

    Humana reported $1.2 billion in profits during the third quarter and is expecting major increases in Medicare Advantage membership, according to the company's Nov. 2 earnings report.
  7. Hundreds of ACA, Medicare call center workers strike over pay, working conditions

    More than 650 ACA and Medicare call center workers went on strike on the first day of the ACA open enrollment period, Nov. 1, over pay and working conditions.
  8. CVS Health attributes $3.4B Q3 loss to opioid lawsuit settlement

    CVS Health raised its annual earnings outlook after beating investor expectations in the third quarter, but the company reported $3.4 billion in losses after agreeing to pay into a global opioid lawsuit settlement starting next year.
  9. Horizon BCBS given OK to reorganize as a mutual holding company

    The New Jersey Department of Banking and Insurance has approved Horizon Blue Cross Blue Shield of New Jersey's application to reorganize its corporate structure as a nonprofit mutual holding company. 

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