Evernorth, the Cigna Group’s health services arm, will cap out-of-pocket costs for Zepbound and Wegovy, two GLP-1 drugs, at $200. Members can save up to $3,600 a year compared to purchasing the drugs directly or through consumer programs, according to…
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AI, digital health and value-based care are among the biggest buzzwords in healthcare — and might be overhyped, according to these payer executives. Becker’s connected with 11 leaders to learn what’s overhyped in healthcare. Like what you see here? Join…
Federal lawmakers have reintroduced the “Improving Seniors’ Timely Access to Care Act,” a bipartisan bill that aims to streamline the prior authorization process for Medicare Advantage enrollees. The proposal would establish an electronic prior authorization process for Medicare Advantage plans,…
CMS’ Interoperability and Prior Authorization Final Rule (CMS-0057-F) outlines the path toward industry-wide electronic prior authorization, but real-world implementation remains fragmented — even among early adopters. From investment hesitancy to misaligned workflows to gaps in CMS provisions, health systems and…
Jun 3, 2025 12:00 PM - 1:00 PM America/Chicago
Presented by:
Presenters
Steven Berkow
Senior Advisor, Value-Based Care, InterSystems
Jessica Jowdy
Manager, Healthcare Sales Engineering, InterSystems
Medicare could face nearly $500 billion in cuts over the next decade under Republicans’ “One Big Beautiful Bill Act,” which also proposes significant reductions to Medicaid and other healthcare programs. According to a May 20 report from the nonpartisan Congressional…
Price transparency mandates have introduced an unprecedented volume of data — but turning that data into actionable strategy remains a challenge. Health systems and payers alike are still navigating how to translate pricing insights into stronger contract terms, smarter network…
Jun 9, 2025 12:00 PM - 1:00 PM America/Chicago
Presented by:
Presenters
Jacob Little
CCO, Payerset
Amy Crowe
VP, PurpleLab
Heather Parker
Director, Healthcare Strategy & Finance, Forvis Mazars
As ASCs face increasing reimbursement complexity — from payer contracts to multi-method payment models — understanding how to optimize managed care contracting has become critical to financial stability. Without a clear understanding of how payer terms dictate claim workflows, ASCs…
Jun 3, 2025 1:00 PM - 2:00 PM America/Chicago
Presented by:
Presenters
Scott Allen
SVP Managed Care Contracting, nimble solutions
Arkansas Blue Cross & Blue Shield reported a $226.2 million net loss in 2024 and a 15% increase in claims exceeding $1 million. President and CEO Curtis Barnett told Arkansas Business in May that members under 40 are generating seven-figure…
Eight Medicare plans have been recognized for high achievement or significant improvement in medication safety and appropriate use by the Pharmacy Quality Alliance. The awards are based on CMS’ 2025 Medicare Part D Star Ratings, where only 1.3% of the…
Leon County, Florida prosecutors have opened a criminal investigation relating to a $10 million donation from Centene to the Hope Florida Foundation, a nonprofit associated with Gov. Ron DeSantis, according to a joint report from the Miami Herald and the…