Today's Top 20 Stories

  1. BCBS North Carolina buys 50+ FastMed urgent care clinics, names CEO

    Jakob Emerson -
    Blue Cross and Blue Shield of North Carolina has purchased all North Carolina locations of FastMed, a national chain of urgent care clinics.

  2. Cigna names new insurance CEO amid leadership shuffle

    Andrew Cass -
    The Cigna Group announced a series of leadership changes, including naming Brian Evanko president and CEO of Cigna Healthcare. 

  3. Humana plans 'limited' layoffs

    Rylee Wilson -
    Humana plans to lay off a small portion of its workforce, the Louisville Courier-Journal reported Jan. 16. 

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  1. MedPAC: Medicare Advantage will receive estimated $88B in overpayments in 2024

    Rylee Wilson -
    Coding intensity and the types of enrollees who select Medicare Advantage plans will drive an additional $88 billion in payments to the program in 2024 compared with what traditional Medicare would receive, according to estimates from the Medicare Payment and Advisory Commission. 

  2. Providence Health Plan names chief medical officer

    Erica Carbajal -
    Laurel Soot, MD, has been named chief medical officer of Providence Health Plan. 

  3. Sanford Health Plan names CEO

    Jakob Emerson -
    Sanford Health Plan has named Tommy Ibrahim, MD, as its new president and CEO.

  4. Centene completes sale of UK hospital operator

    Andrew Cass -
    Centene has completed the sale of Circle Health Group, one of the U.K.'s largest independent hospital operators, to Pure Health. 

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  1. Alignment Healthcare names COO, chief people officer

    Rylee Wilson -
    Alignment Health has named Sebastian Burzacchi as chief operating officer of its management services organization and Andreas Wagner as chief people officer. 

  2. Hospitals aren't breaking up with Medicare Advantage, UnitedHealth says

    Rylee Wilson -
    Though some contract negotiations with providers came "down to the wire" last year, UnitedHealthcare executives said the payer did not see more contract splits than usual in 2023. 

  3. RSV vaccines drove rising Medicare Advantage costs, UnitedHealth execs say

    Rylee Wilson -
    RSV vaccinations brought more older adults to their primary care offices in the last months of 2023, one factor behind rising medical costs in Medicare Advantage, UnitedHealth Group executives said. 

  4. UnitedHealth Group posts $5.5B profit in fourth quarter

    Jakob Emerson -
    UnitedHealth Group recorded double-digit growth in revenue year over year across its core lines of business at UnitedHealthcare and Optum, according to the company's fourth quarter earnings report released Jan. 12.

How one Midwest hospital is driving financial efficiency with interconnected systems

Sponsored
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. Trinity, Anthem ink 'breakthrough' value-based Epic partnership

    Jakob Emerson -
    Livonia Mich.-based Trinity Health and several Anthem BCBS health plans have signed a new multi-year provider network contract that includes advanced collaboration on data connectivity and value-based reimbursement models through the Epic Payer Platform.

  2. SCAN Group names VP of policy and government affairs

    Rylee Wilson -
    SCAN Group tapped Matt Kazan as vice president of policy and government affairs. 

  3. What's going wrong with Medicaid redeterminations

    Rylee Wilson -
    Outdated eligibility systems and staff shortages are making the Medicaid redetermination process more difficult, state officials told KFF. 

  4. The Medicare Advantage landscape in 2024: 10 updates

    Jakob Emerson -
    More seniors and dual-eligible individuals continue to enroll in Medicare Advantage plans, but the number of plans available decreased in 2024, according to an AHIP report published Jan. 9.

  5. CMS pitched prior authorization overhaul, but timeline remains uncertain

    Andrew Cass -
    In December 2022, CMS pitched a rule it said would streamline the prior authorization process. But 10 months after closing public comment, it remains uncertain when — or if — the proposal will be finalized, KFF Health News reported Jan. 9. 

  6. 4 Medicare Advantage contracts recently terminated by CMS

    Jakob Emerson -
    CMS uses star ratings to determine the quality of Medicare Advantage prescription drug plans. The agency may terminate a plan sponsor's contract to administer Medicare benefits if it achieves a rating of less than three stars for three consecutive contract years.

  7. ACA signups surpass 20 million for the 1st time

    Rylee Wilson -
    Over 20 million people have enrolled in individual insurance plans on the ACA exchange for 2024, CMS said Jan. 10. 

  8. Pennsylvania launches website for appealing denied health insurance claims 

    Jakob Emerson -
    The Pennsylvania Insurance Department has launched an online independent appeal process for state residents who believe their health plan wrongly denied a medical claim.

  9. Elevance Health to offer smartphones to some Medicaid beneficiaries

    Rylee Wilson -
    Elevance Health will provide smartphones with unlimited talk, text and data to some of its Medicaid members. 

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