Today's Top 20 Stories
  1. North Carolina's unique new Medicaid challenge

    North Carolina is expanding its Medicaid program to an additional 300,000 people in December, but the state is facing unique enrollment challenges amid Medicaid redeterminations, The Washington Post reported Oct. 11.
  2. Envision CEO will be Humana's next top exec

    Envision Healthcare president and CEO Jim Rechtin will be Humana's next CEO. 
  3. Lawmakers are scrutinizing managed care

    Federal lawmakers have been probing payers on a variety of issues in recent months, raising concerns on prior authorizations, Medicare Advantage costs, artificial intelligence and more. 

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. Push for Florida Medicaid disenrollment pause continues

    Advocates are calling for Florida to pause Medicaid enrollments and reinstate coverage for eligible children, as the state defends itself against a potential class action lawsuit. 
  2. Arkansas completes Medicaid redetermination speed run, disenrolls 370,000

    Arkansas has completed its Medicaid unwinding process, one of the first states to do so. 
  3. 6 health systems launching Medicare Advantage plans

    Some health systems may be dropping patients with Medicare Advantage plans, but others are continuing to expand into the MA market or are entering it for the first time in 2024.
  4. Cigna's Evernorth buys telehealth platform

    The Cigna Group's Evernorth Health Services is purchasing telehealth platform for an undisclosed amount to enhance its existing virtual services through MDLive.

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. 9 Medicare Advantage plans with NCQA's Health Equity accreditation

    Just nine Medicare Advantage plans have obtained the National Committee for Quality Assurance's health equity accreditation. 
  2. California again weighs single-payer system

    The appetite for a single-payer health system in California is growing, with plans to introduce a bill in early 2024, according to a Bloomberg report.
  3. The 'wild west' of Medicare Advantage, and how to fix it

    The average older adult has dozens of Medicare Advantage plans to choose from, and many turn to brokers to help them make a decision about the best option for them. 
  4. University Hospitals launches Medicare Advantage plan with PrimeTime Health Plan

    Cleveland-based University Hospitals is launching a co-branded Medicare Advantage plan with PrimeTime Health Plan. 

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. HealthPartners to launch hybrid, prevention-focused care plans

    HealthPartners, an integrated payer-provider organization, is launching a new hybrid preventive care offering designed around health screenings, immunizations and other routine care.
  2. 29 ways payers can improve equity

    Health plans are working to improve health equity, appointing chief health equity officers, improving data collection and implementing initiatives to reduce disparities in health outcomes. 
  3. Phoenix Children's, Aetna strike deal

    Phoenix Children's and Aetna have reached a new contract agreement. 
  4. Oregon health system drops Humana, Centene Medicare Advantage plans

    St. Charles Health System in Bend, Ore., will no longer be in-network with Humana and Centene subsidiaries HealthNet and WellCare Medicare Advantage plans in 2024. 
  5. Medicare Advantage in the headlines: 10 recent updates

    As open enrollment for Medicare approaches, payers are striking partnerships with Instacart and Meijer and expanding to new markets. 
  6. The healthiest states for women and children in 2023, per UnitedHealth

    For women and children, Minnesota is the healthiest state in the nation while Mississippi is the least healthy, according to the "2023 Health of Women and Children Report" from the United Health Foundation.
  7. UnitedHealthcare names CEO for exchange plans

    UnitedHealthcare has promoted Marcus Robinson to CEO of its individual and family plans business.
  8. How UnitedHealthcare cut employers' healthcare costs by 15%

    UnitedHealthcare's deductible-free health plan saved money for employers and employees, according to an Oct. 5 news release from the insurer. 
  9. OIG: Aetna received estimated $25.5M in Medicare Advantage overpayments

    Aetna received $632,070 in overpayments for Medicare Advantage claims from 2015 to 2016, an audit from HHS' Office of Inspector General found. 

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