Today's Top 20 Stories
  1. Court blocks Medicare Advantage broker fee caps

    A federal judge has paused implementation of CMS regulations capping the amount Medicare Advantage companies can pay brokers that sell their plans. 
  2. OIG to probe whether Medicare Advantage plans deny post-acute care

    HHS' Office of Inspector General will audit Medicare Advantage plans' use of prior authorization in post-acute care settings. 
  3. 5 more states to provide Medicaid coverage to incarcerated people

    CMS has approved requests from five states to provide Medicaid coverage to incarcerated people before they are released. 

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  1. Cigna's Express Scripts Tricare contract anti-competitive, lawmakers allege

    A group of 24 lawmakers expressed concern Express Scripts could be limiting Tricare beneficiaries' choice of pharmacies. 
  2. 15 payers cutting jobs | 2024

    Payers are trimming their workforces and cutting jobs due to financial or operational challenges, along with restructuring strategies. 
  3. Texas fines Cigna $600K for claims disputes issues

    Texas has fined Cigna $600,000 for failing to comply with multiple independent claims dispute resolution requirements under state law. 
  4. Health insurance markets ranked by gross margins, MLRs

     In 2023, gross margins per member were highest in the Medicare Advantage market, and medical loss ratios were lowest in the individual market, according to a July 2 analysis from KFF.

How one Midwest hospital is driving financial efficiency with interconnected systems

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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. Massachusetts uses urgent care centers to tackle 'severe' hospital ED volumes

    The Massachusetts Department of Public Health has launched an initiative that redirects patients not needing emergency-level care to urgent care providers to address "severe capacity challenges" at hospital emergency departments in the eastern part of the state.
  2. 7 Medicare Advantage plans snag 5-star ratings after CMS redo

    Seven additional Medicare Advantage contracts picked up five-star ratings from CMS after the agency recalculated its ratings for 2024. 
  3. AmeriHealth Caritas lays off 102

    AmeriHealth Caritas has laid off 102 employees, the Philadelphia Inquirer reported July 2. 
  4. UnitedHealth Group in the headlines: 10 updates

    Here are 10 updates on UnitedHealth Group and its subsidiaries that Becker's has reported since June 17: 

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. Sentara Health Plans, Virginia Children's Care Network strike value-based partnership

    Sentara Health Plans and Virginia Children's Care Network are launching a value-based partnership to improve outcomes and lower costs for children enrolled in Medicaid. 
  2. Independence Blue Cross names 2 VPs

    Independence Blue Cross has named two new vice presidents. 
  3. Humana among potential buyers of Walmart clinics: Report

    Walmart has held talks with Humana about a potential sale of its shuttered Walmart Health clinics, Fortune reported July 2. 
  4. Terminated BCBS Tennessee employee wins COVID vaccine mandate case

    A federal jury has awarded a former BlueCross BlueShield of Tennessee employee nearly $700,000 after she was terminated for refusing to get vaccinated against COVID-19 in 2021.
  5. UnitedHealthcare, Trinity hospitals split in 6 states

    Several Trinity Health hospitals from coast to coast are now out of network with UnitedHealthcare amid reimbursement disputes between the organizations.
  6. Oregon expects to insure 100,000 under new program

    Oregon has launched a program to provide Medicaid benefits to individuals earning up to 200% of the federal poverty level, the Oregon Capital Chronicle reported July 1. 
  7. How this BCBS CEO approached his 1st year on the job

    Culture, relationships and strategy were Blue Cross Blue Shield of Nebraska CEO Jeff Russell's top three priorities in his first year on the job. 
  8. FDA: Payers should play larger role in clinical trials

    Payers are "crucial allies" in improving data gathered from clinical trials, researchers at the FDA and Philadelphia-based University of Pennsylvania wrote in a special communication published in JAMA July 1. 
  9. What do members want? 14 top-ranked plans weigh in

    Members want more from their health plans, and the top-performing plans are finding more ways to connect with them on the phone, online and in person. 

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