Today's Top 20 Stories
  1. Why health equity won't come from a spreadsheet, per 1 UPMC insurance executive

    Pittsburgh-based UPMC will transfer 6 million patient records from nine EHRs to Epic Systems by mid-2026, a move that will enable its clinicians with better data to improve health equity and quality, according to Johanna Vidal-Phelan, MD.
  2. Blues plans dive into care delivery

    As the nation's largest insurers have evolved to become health services organizations capable of providing healthcare and paying for it too, several Blue Cross Blue Shield companies are following suit and becoming providers as well.
  3. Moody's: Payers' 2023 outlook is stable

    Insurers' outlook is stable for 2023, but high Medicare Advantage utilization rates could present challenges, Moody's said in a Nov. 20 report. 

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. Medicaid in the headlines: 7 recent updates

    New research found the number of self-pay patients increased as enrollees lost Medicaid coverage, and Georgia lawmakers are mulling a full expansion of the state's Medicaid program. 
  2. CMS cut Medicaid improper payments in 2023

    The Medicaid improper payment rate significantly decreased from 2022 to 2023, CMS reported Nov. 15. 
  3. Medicare solvency would be extended 17 years under Medicare Advantage utilization rates: Study

    The Hospital Insurance Trust Fund would be solvent until 2048 if traditional Medicare utilization levels were similar to those under Medicare Advantage, according to research published in October by AHIP and conducted by Avalere. 
  4. Insurers aren't following CMS' new Medicare Advantage rules, AHA says

    Some Medicare Advantage plans are not planning to comply with new CMS guidance requiring plans to follow traditional Medicare's standards for coverage decisions, the American Hospital Association alleges. 

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. UnitedHealth subsidiary's ASC deal facing scrutiny from Connecticut regulators

    Connecticut hospital regulators want more information from UnitedHealth subsidiary SCA Health over its attempts to acquire controlling interest in a surgical center in the state, CT Insider reported Nov. 21.  
  2. CMS: Medicare Advantage received $16.6B in improper payments in 2023

    CMS paid Medicare Advantage organizations an estimated $16.6 billion in overpayments in fiscal year 2023, the agency reported Nov. 15. 
  3. More employers consider narrow networks, low deductibles

    Four in 10 employers offer low or no-deductible plans, and 15% of employers will offer their employees coverage with no premium, according to Mercer's "Health and Benefit Strategies for 2024" report. 
  4. 6 payers expanding ACA offerings in 2024

    From UnitedHealth expanding plans to 26 states total to Centene expanding its footprint within 11 markets, these are six payers expanding their exchange offerings in 2024.

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. 25 states with 'failing' Medicaid redetermination grades

    Half of states are "failing" amid the Medicaid redeterminations process, according to the NAACP. 
  2. Elevance Health names staff VP of social impact and equity

    Elevance Health has named Melissa Sherry, PhD, staff vice president of social impact and equity.
  3. 3 payer CEOs among healthcare's 'most overpaid'

    Three payer CEOs are among As You Sow's list of the most "overpaid" CEOs at S&P 500 companies. 
  4. Excellus BCBS awards $28M to 31 hospitals

    Excellus BlueCross BlueShield awarded 31 upstate New York hospitals and health centers a combined $28 million in 2022 for quality care improvements.  
  5. HHS' call to action for payers on health equity

    CMS issued its first-ever playbook to address social determinants of health Nov. 16. 
  6. Georgia mulls Medicaid expansion

    Georgia Republican lawmakers heard testimony on possible Medicaid expansion for the first time in a decade, The Atlanta Journal-Constitution reported Nov. 17. 
  7. Demand for no-premium Medicare Advantage plans hits plateau: Report

    Fewer Medicare Advantage beneficiaries are choosing no-premium plans for 2024, according  to eHealth's November snapshot report that tracks MA and Part D plans selected by beneficiaries in the first half of the current annual enrollment period, or Oct. 15 to Nov. 8. 
  8. Tennessee extends Medicaid contracts without Centene

    Tennessee has extended three managed Medicaid contracts with UnitedHealthcare, BCBS and Elevance's Amerigroup for one additional year, the Tennessee Lookout reported Nov. 15.
  9. Medicare Advantage in the headlines: 9 recent updates

    UnitedHealthcare is facing a lawsuit of alleged wrongful Medicare Advantage care denials, and lawmakers are eyeing new regulations on the program. 

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