EmblemHealth will pay $2.5 million after an investigation by the New York attorney general’s office found the insurer violated parity laws and failed to ensure access to mental healthcare services because of inaccurate listings, also known as “ghost networks.” The office launched…
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UCare is in the throes of a state takeover in Minnesota, with health systems and former employees voicing concerns over the insurer’s rehabilitation. The insurer posted an operating loss of $504 million in 2024 and shared plans to exit the…
Optum has launched Value Connect, an AI-powered platform designed to help payers and providers operationalize value-based care models by combining clinical, operational and financial data into a single system. The platform uses AI across quality measures, utilization patterns and risk…
Nevada identified insurer violations of mental health laws based on nonquantitative treatment limitations, according to a Dec. 31 report from the state’s insurance division. To better understand adherence to the Mental Health Parity and Addiction Equity Act, reviewers requested information…
A former senior director of data analytics at Optum was found guilty of defrauding the company out of more than $1.2 million through a scheme involving a fraudulent hire and salary kickbacks. What happened? What’s next?
One in 10 Medicare Advantage enrollees were forced to disenroll from their health plan heading into 2026 due to insurer exits from the market, a tenfold increase from historical averages, according to a study published Feb. 18 in JAMA. The…
Traditional automation has improved efficiency, but it remains limited by static rules and predefined workflows. As operational complexity increases, leaders are expected to make faster, more accurate decisions across revenue cycle, care delivery and population health — often without the…
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Healthcare finance leaders are being pitched on rebate upside. But many programs underperform not because the math was wrong, but because adoption never materialized. This session breaks down what drives ROI in B2B payment programs and how leading healthcare finance…
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Michele Retzbach
Principal Solutions Consultant, AvidXchange
Paul Markovich, president and CEO of Ascendiun, the parent company of Blue Shield of California, is not one to sugarcoat the state of the healthcare system. “I don’t see how you can look at it and say there isn’t a…
BCBS Michigan saved $67 million and $80 million in 2024 and 2025, respectively, through biosimilar use, the insurer reported Feb. 17. The company began moving members from Humira and Stelara to alternatives like Simlandi and Yesintek in 2025. Currently, 99%…