Today's Top 20 Stories
  1. Bright Health owes CMS $380M in risk adjustment payments

    Bright Health owes CMS $380 million in risk adjustment payments from its shuttered insurance business, the company said Sept. 19. 
  2. Medicare Advantage beneficiaries with Alzheimer's disease more likely to switch to traditional Medicare: Study

    Medicare Advantage beneficiaries with Alzheimer's disease and related dementia are 1.4 times more likely to switch to traditional Medicare than their counterparts without the disease, a study published Sept. 15 in JAMA Health Forum found. 
  3. Magellan Health taps two market leaders

    Magellan Health, a subsidiary of Centene, has named Arthur Hennig as senior vice president and chief business officer for payer markets and Sara Pierce as senior vice president and chief business officer for the employer market.

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. 9 top execs that have recently left Elevance Health

    From the CFO of its government business division to the COO of Carelon, these are nine executive departures from Elevance Health and its subsidiaries over the last year:
  2. Ex-Cigna employee agrees to pay $33K to settle insider trading allegations

    Former Cigna employee Jonathan Ferrie will pay more than $33,000 to settle insider trading allegations from the U.S. Securities and Exchange Commission. 
  3. HHS finalizes rule to streamline enrollment in Medicare Savings plans

    Greater access to care and making such care more affordable may be on the horizon for lower-income older adults and people with disabilities after the Department of Health and Human Services and CMS finalized a rule to streamline enrollment in the Medicare Savings Programs. The move was described in a Sept. 18 news release as the most significant HHS action in a decade for such care.
  4. Aetna to enter Maryland ACA exchange 

    Aetna has filed to offer individual health plans on the Maryland ACA exchange in 2024.

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. AmeriHealth Caritas names Florida market president

    AmeriHealth Caritas has named Melody Bonomo as Florida market president. 
  2. The fate of North Carolina's Medicaid expansion could be tied to casinos

    North Carolina lawmakers are proposing tying funding to expand the state's Medicaid program to a bill approving four new casinos in the state, the News and Observer reported Sept. 18. 
  3. Oregon to establish basic health program for lower income adults

    Oregon is asking CMS to approve a basic health program for lower-income individuals who make too much to qualify for Medicaid, a move that could raise premiums prices on the state's individual insurance market. 
  4. 18 recent payer CEO moves

    From several new Blue Cross Blue Shield CEOs to a shakeup at Optum, these are 18 payer CEO moves reported by Becker's since Jan. 1:

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. New York's Medicaid program paid $388M for federally-funded services, audit shows

    New York's Medicaid program paid $388 million for medical services between 2016 and 2022 that should have been paid by federally-funded plans such as Medicare, according to two audits from the state's comptroller published Sept. 14.
  2. BCBS Texas funds doula education program

    Blue Cross and Blue Shield of Texas is partnering with Huston-Tillotson University, a historically Black university in Austin, Texas, on a new program aimed at educating doulas. 
  3. Cigna program aims to reduce out-of-pocket costs for musculoskeletal conditions

    Cigna Healthcare is offering employers a supplemental benefit designed to help employees diagnosed with musculoskeletal conditions. 
  4. Aetna in the headlines: 7 recent updates

    CVS Health said it will lay off over 500 Aetna employees in the coming weeks, and the company welcomed a new president of Aetna in September. 
  5. UnitedHealthcare, Cigna prior authorization cuts not to be confused with major progress: AMA

    UnitedHealthcare and Cigna's prior authorization cuts are steps in the right direction, but the American Medical Association is "careful not to confuse positive developments with major progress," the organization's immediate past president Jack Resneck, MD, said. 
  6. Nevada adds 114,000 residents back to Medicaid rolls

    A federal policy change has allowed Nevada reinstate Medicaid coverage to 114,000 residents who lost coverage because they did not return their renewal documentation. 
  7. UnitedHealth Group to leave HQ building for Optum campus

    UnitedHealth Group will move from its headquarters building in Minnetonka, Minn., to Optum's campus in Eden Prairie, Minn., in 2024, the Minneapolis/St. Paul Business Journal reported Sept. 18. 
  8. NCQA: The best-rated commercial health plans in each state | 2023

    The National Committee for Quality Assurance has named the best commercial health plans of 2023 based on factors that include care quality, patient satisfaction and efforts to keep improving.
  9. Blue Cross of Idaho names chief medical officer, COO

    Blue Cross of Idaho has named Melissa Kizilos, MD, as chief medical officer and Leslie Carter as chief operations officer. 

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