Oscar Health is expecting to operate at a loss in 2025 as costs climb in the individual market. The company reported preliminary results for the second quarter of 2025 on July 22, expecting a loss from operations of $200 million…
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Humana is accelerating its efforts to reform the prior authorization process through a series of new policies, following the broader insurance industry’s recent pledge to reduce and streamline prior auth requirements. By January 1, 2026, Humana will eliminate one-third of…
The Medicare Part D market is facing an “uncertain future,” according to an analysis from KFF published July 16. The future of the Part D market depends on whether CMS extends the Part D premium stabilization program put in place…
Many health plans still rely on basic segmentation and static messages — leaving members feeling like numbers. But the stakes are rising fast: With heightened expectations and fierce competition, payers must deliver timely, relevant experiences to keep members engaged. Join…
Aug 27, 2025 1:00 PM - 2:00 PM America/Chicago
Presented by:
Presenters
Robert Connely
Pega Systems – Healthcare Industry Market Leader at Pega Systems
Lori Logan
President & CEO, NASCO
Tina Galloway
Vice President, Enterprise Client Executive, Optum
Mike Gerrish
From Member Frustration to Member Loyalty: And the role of AI
ACA premiums are set to rise by 15% on average in 2026, The Wall Street Journal reported July 18. The Journal used data analyzed by KFF to report rate increases for the largest insurers in 19 states. BCBS Illinois is…
Integrating AI into utilization management (UM) holds great promise. However, but without the right foundation, adoption stalls. At Sharp HealthCare, leadership knew that selecting the right AI tool was only part of the puzzle. They built a deliberate change management…
On Demand
Presented by:
Presenters
Zachary Lenert, MSN, RN, NEA-BC, AMC
VP of Integrated Care Management Sharp Healthcare
Tonya Soroosh, MSJ, RN, CCM
System Director, Case Management Sharp Healthcare
A new Alaska law takes effect on Jan. 1, 2026 that requires faster responses to prior authorization requests for certain treatments and services, the Alaska Beacon reported July 18. Under the new law, payers are required to notify patients within…
With GLP-1 medication costs being a top concern for employers heading into 2026, UnitedHealthcare is addressing the challenge through its Total Weight Support program, aimed at improving weight loss outcomes for employees while managing the costs of medication adherence. “In…
UnitedHealthcare’s specialty benefits CEO, Tom Wiffler, is departing from his role after more than 25 years with the company. Since 2017, Mr. Wiffler led the insurer’s dental, vision, disability, life insurance, indemnity products, hearing, pet insurance, and stop loss businesses.…
Canton, Ohio-based Aultman Health System will no longer offer individual and family ACA plans, along with small group insured ACA plans, past 2025, the Canton Repository reported July 21. The system’s insurance arm, AultCare, insures about 100,000 people. About 6,000…