Today's Top 20 Stories
  1. Prisma Health still wants a restraining order against UnitedHealthcare

    Greenville, S.C.-based Prisma Health is asking a judge to reconsider its request for a restraining order against UnitedHealthcare over allegations the insurer breached its confidentiality agreement with Prisma, as the two sides approach a Jan. 1 deadline to reach a new network agreement. 
  2. Where Cigna sees opportunity in weight loss drugs

    The Cigna Group is expecting a program that offers employers ways to manage the high cost of new weight loss drugs to grow. 
  3. Humana, Memorial Hermann at impasse as deadline nears

    Houston-based Memorial Hermann issued termination notices for Humana's Medicare Advantage HMO and PPO networks and could go out of network if a new deal is not reached by Jan. 1, Houston Public Media reported Jan. 1. 

The state of AI in healthcare

86% of healthcare leaders say AI will define success over the next 5 years. Insights + strategies for successful adoption here.
  1. Payers ranked by Q3 revenue, profit

    The nation's largest payers have filed their third-quarter earnings reports, revealing which grew their revenues and net incomes the most year over year. Individual BCBS company revenues and profits in the first half of 2023 are also available.
  2. Medicare Advantage members have fewer hospital readmissions than traditional Medicare: Report

    Medicare Advantage enrollees have 70% lower hospital readmission rates than their counterparts in fee-for-service Medicare, a white paper from researchers at Boston-based Harvard Medical School and software firm Inovalon found. 
  3. Why SCAN Group is betting on population-specific Medicare Advantage plans

    There are nearly 4,000 Medicare Advantage plans for older adults to choose from nationwide for 2024, and payers are launching unique benefits aimed at serving specific and segmented populations.
  4. Most insured patients on Wegovy pay less than $25 per month: Novo Nordisk

    Eighty percent of patients in the U.S. with insurance coverage who are taking Novo Nordisk's weight loss drug Wegovy pay less than $25 a month for the drug, CNBC reported Nov. 2. 

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. CVS names Aetna Medicaid president

    CVS Health has named Mark Santos as president of Aetna Medicaid. 
  2. Humana payment rates for diabetes with complications

    Humana PPO payment rates for diabetes with complications ranged from $31,998 for Houston-based Memorial Hermann to $6,376 for Johnson City, Tenn.-based Ballad Health, according to data compiled by Hospital Pricing Specialists.
  3. Optum to move out of 54-acre Minnesota campus by year's end

    Optum will move out of an Eden Prairie, Minn.-based campus with 473,000 square feet of office space by the end of 2023, the Minneapolis/St. Paul Business Journal reported Nov. 2. 
  4. Medicaid disenrollments top 10 million

    More than 10 million people have been disenrolled from Medicaid since continuous coverage requirements ended in April, according to KFF. 

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. Cigna taps dental and vision VP

    Cigna has named Manish Naik vice president of the company's dental and vision businesses. 
  2. Kamala Harris spotlights AI's potential harm in health insurance

    Vice President Kamala Harris said that while artificial intelligence has the potential to do profound good, it also has the potential to cause profound harm, and that potential for harm includes actions by health insurance companies. 
  3. Cigna posts $1.4B profit in Q3

    The Cigna Group raised its year-end revenue projections to $192 billion, according to the company's third quarter earnings published Nov 2.
  4. UnitedHealth violated labor laws during layoffs, former employees allege in lawsuit

    UnitedHealth Group and Optum violated state and federal employee notification laws during mass layoffs that occurred earlier this year, two former employees allege in a lawsuit filed Oct. 30 in a California federal court. 
  5. Medica names CEO

    Medica has named Lisa Erickson as its next president and CEO. 
  6. Humana: COVID-19 hospitalizations driving higher Medicare Advantage costs

    An increase in COVID-19 inpatient admissions is one factor driving higher utilization rates in Medicare Advantage, Humana executives said. 
  7. Centene partners with Walmart

    With open enrollment underway, Centene's Ambetter from Sunshine Health, the payer's ACA subsidiary in Florida, is adding Walmart Health centers to its preferred provider network.
  8. Humana posts $832M profit in Q3

    Humana reported a 30% decline in net income year over year in the third quarter of 2023. 
  9. UnitedHealthcare's 2nd wave of prior authorization cuts begins

    The second and final wave of UnitedHealthcare's prior authorization cuts began Nov. 1. 

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