Today's Top 20 Stories
  1. UnitedHealth wants Medicare Advantage algorithm denials suit tossed

    UnitedHealth Group said a proposed class-action lawsuit alleging an AI algorithm wrongfully denied Medicare Advantage patients care should be dismissed because "plaintiffs have failed to exhaust the exclusive administrative appeal process set by the Medicare Act for challenging coverage determinations."
  2. New York City continues push for Aetna Medicare Advantage plan

    New York City Mayor Eric Adams plans to ask the state's highest court to allow the city to implement an Aetna Medicare Advantage plan for its retired employees, the New York Daily News reported May 21.
  3. New York health plans pitch merger

    Two New York health plans intend to merge, creating an organization with nearly 2 million members and 6,000 employees. 

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. 10 payers among Forbes' best employers for new grads

    10 payers were named in Forbes' annual "America's Best Employers for New Grads" list, published May 21.
  2. Another state tackles prior authorization

    An Oklahoma bill reforming the prior authorization process has been signed into law and goes into effect Jan. 1, The Journal Record reported May 21. 
  3. States ranked by ACA enrollment growth since 2020

    The ACA marketplace hit a record enrollment high of 21 million in 2024, buoyed by federal premium subsidies. In 2020, ACA enrollment was 11 million.
  4. Medicare Advantage in the headlines: 7 recent updates

    More hospitals are cutting ties with Medicare Advantage plans, and some insurers are bracing for membership losses in 2025. Here are seven Medicare Advantage updates Becker's has reported since May 8. 

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. Centene plans $900M affordable housing investment

    Through pre-development loans, Centene and building developer McCormack Baron Salazar will enable around $900 million in planning and construction-related activity to accelerate the development of affordable housing. 
  2. Vermont governor signs prior authorization reform bill

    Vermont Gov. Phil Scott has signed a bill to reform the prior authorization process in the state.
  3. GuideWell subsidiary notifying 2.4 million members of data breach 

    GuideWell subsidiary WebTPA, a health benefits administrator, has started notifying more than 2.4 million members about a data breach that occurred in April 2023, The HIPAA Journal reported May 20.
  4. Promise of VBC: The imperative of care management programs to focus on low-risk members

    Preventive care delivery is one of the inalienable levers of value-based care (VBC). With the increasing VBC adoption, many healthcare payers have been offering care management programs that aim to promote overall member wellness by managing members’ medical conditions and preventing progression of chronic diseases.

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. 8 recent payer lawsuits, settlements

    Here are eight lawsuits, settlements and legal developments involving payers that Becker's has reported since April 1: 
  2. 10 key questions facing Medicare Advantage

    Medicare Advantage is the dominant form of Medicare, and questions loom for payers, providers and policymakers alike in the year ahead. 
  3. Blue Shield of California names president, VP of strategic initiatives

    Blue Shield of California has appointed two new senior executives. 
  4. ICHRA growth up nearly 30% since 2023

    Employer adoption of ICHRAs is up 29% since 2023, according to a May 16 report from the HRA Council.
  5. UnitedHealthcare looks to offload 87K square feet of Wisconsin office space 

    UnitedHealthcare is looking to lease 87,000-square-feet of office space in suburban Green Bay, Wis. following the company's move to more hybrid work schedules, CoStar News reported May 14.
  6. Nebraska health system to drop all Medicare Advantage plans

    North Platte, Neb.-based Great Plains Health plans to stop contracting with Medicare Advantage plans in 2025. 
  7. Medicare spending on weight loss drugs may be lower than previously thought: Report

    Medicare spending on GLP-1 medications may not be as high as some estimates predict if coverage was expanded to cover weight loss, according to an analysis from data firm Intensity. 
  8. HCSC plans Texas office, job creation initiative

    Health Care Service Corp. is planning a 132,000-square-foot office in southwest Houston. 
  9. Lawsuit alleges UnitedHealth failed to disclose antitrust investigation

    UnitedHealth Group is facing a proposed securities fraud class-action lawsuit alleging that the company failed to disclose that the Justice Department opened an antitrust investigation into the company. 

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