Today's Top 20 Stories
  1. Medicare Advantage AI under more fire in Washington

    New guardrails for Medicare Advantage plans' use of AI may not be clear enough, experts told members of the Senate Finance Committee. 
  2. Cigna names general manager for North Texas, Oklahoma

    Cigna Healthcare has named Mike Cole as general manager for its employer business in North Texas and Oklahoma. 
  3. Optum's plan to buy Oregon physician group gets pushback

    Hundreds of people, including physicians, patients and Oregon Senate Majority Whip Sara Gelser Blouin, have urged the state department of health to block Optum's proposed acquisition of Corvallis (Ore.) Clinic, the Corvallis Gazette-Times reported Feb. 8.

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  1. Payers ranked by total membership | Q4 2023

    UnitedHealthcare ended 2023 with the largest total membership of large payers across Medicare, Medicaid, military, commercial and individual business. 
  2. CMS issues AI guidance for Medicare Advantage plans

    Algorithms and artificial intelligence-powered software tools can be used to support Medicare Advantage plans in making coverage decisions for members, but payers are still bound by CMS' internal benefits requirements and nondiscrimination rules under the ACA, the agency said in guidance to insurers regarding its final 2024 MA rule.
  3. Former CMS administrator: 'I would like to see Medicare Advantage slowed or stopped'

    Medicare Advantage is now the dominant form of Medicare in the U.S., with a projected 54% share by the end of 2024, or more than 33 million enrollees.
  4. Payers ranked by Medicare Advantage membership | Q4 2023

    UnitedHealthcare is still the largest Medicare Advantage insurer in the U.S. 

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  1. CVS Health seeks executive director of payer contracting

    CVS Health is looking for an executive director of payer contracting to provide strategy and oversight of the company's primary care contracts.
  2. Wellmark BCBS, U of Iowa partner on insurance degree program

    Wellmark Blue Cross and Blue Shield has partnered with the University of Iowa on a risk management and insurance degree program.
  3. Centene names chief impact officer

    Centene has promoted its chief diversity, equity and inclusion officer, Erika McConduit, to chief impact officer.
  4. UnitedHealth Group's president and COO to retire

    UnitedHealth Group president and COO Dirk McMahon plans to retire April 1. 

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. Payer execs sweat proposed Medicare Advantage rates

    Payer executives are not happy with CMS' proposed Medicare Advantage rates for 2025. 
  2. California payer drops 4 Prime hospitals

    CalOptima, a Medicaid insurer in Orange County, Calif., terminated its contract with four hospitals owned by Ontario, Calif.-based Prime Healthcare on Feb. 5.
  3. Humana study builds on health literacy efforts

    Asking Medicare Advantage members a single question over the phone can help determine their health literacy status, a study from Humana published in the American Journal of Managed Care Feb. 7 found. 
  4. Cigna's Medicare sale is an uphill battle for HCSC: Moody's

    It's going to be a difficult task for Health Care Service Corp. to turn Cigna's Medicare business into a financially successful endeavor, according to a Moody's analysis shared with Becker's.
  5. Payers ranked by medical loss ratios in 2023

    The nation's largest payers have filed their fourth-quarter earnings reports, revealing how medical loss ratios changed year over year.
  6. Georgia sues federal government over Medicaid work program

    Georgia is suing the Biden administration to keep the state's partially expanded Medicaid expansion program running until Sept. 30, 2028, the Georgia Recorder reported Feb. 2. 
  7. Big payers ranked by 2023 revenue

    The nation's largest payers have filed their fourth-quarter earnings reports, revealing which recorded the largest revenues in 2023.
  8. The 10 best payer tools, per KLAS

    KLAS Research, a healthcare IT data and insights company, named its "Best in KLAS" payer tools for 2024. 
  9. CVS Health cuts earnings guidance amid rising Medicare Advantage costs

    Facing rising spending in Medicare Advantage, CVS Health lowered its 2024 earnings guidance. 

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