Many payers still rely on brokers to manage nonemergency medical transportation (NEMT). This model is rife with inefficiencies, including misaligned incentives, fraud risk, outdated workflows and lack of data visibility. Missed appointments, access delays and rigid advance-notice requirements can increase…
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CareSource has named David Thomas as president of the company’s Ohio market. Mr. Thomas was most recently CEO of markets and Medicaid at Centene, according to a news release shared with Becker’s July 7. He was named CEO of Centene’s…
Tools that allow providers to see prescription cost estimates at the time of prescribing did not have any effect on cost, a study published July 3 in JAMA Network Open found. The cohort study included 2.8 million Medicare Advantage beneficiaries…
A federal court has partially ruled in favor of Alignment Healthcare in a legal challenge against CMS, resulting in the Medicare Advantage company’s Arizona HMO star rating being raised from 3.5 to 4 stars. All of Alignment’s members are now…
Shifting regulations, rising demand for care and staffing shortfalls have put the healthcare industry in a constant state of flux. Decisive leadership during times of ambiguity is critically important. To create a sustainable competitive advantage, healthcare organizations must identify market…
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America’s behavioral-health crisis is intensifying, marked by soaring demand for mental health services and a nationwide shortage of psychiatric clinicians. To close these gaps, seamless coordination across every level of care is essential. To make mental health support even more…
Presented by:
Dr. Christopher Ott
Chief Medical Officer Physician Services at HCA Healthcare Clinical Services Group
Dr. Georgia Gaveras
Co-Founder and Chief Medical Officer of Talkiatry
Robert Krayn
Co-Founder and CEO of Talkiatry
S&P Global Ratings is considering downgrading Centene’s credit rating to junk status. In a July 1 news release, the agency cited Centene withdrawing its 2025 earnings guidance as the driver for the potential downgrade. Centene’s Medicare, Medicaid and ACA businesses are…
Health Care Service Corporation has launched its national HealthSpring brand following the company’s acquisition of Cigna’s Medicare business. In March, HCSC purchased Cigna’s Medicare Advantage, Part D and supplemental benefits businesses, along with a value-based care management subsidiary, for $3.3…
Generative AI for clinical documentation has shown significant promise in reducing administrative workloads, alleviating clinician burnout, and enhancing the patient experience. Yet there remains untapped potential in leveraging patient-clinician conversations to automate critical business functions, particularly across revenue cycle management.…
Presented by:
Dr. Charles Frazier
SVP and Chief Medical Information and Innovation Officer, Riverside Health
Matthew Cox
Chief Financial Officer, Corewell Health
Chris Bergman
VP and Chief Financial Officer, Dayton Children’s Hospital
Sagar Sanghvi
Chief Financial Officer, Abridge
Total risk adjustment payments in individual and small group insurance plans increased modestly in 2024, according to new data from CMS. The agency published its annual summary report of risk adjustment payments June 18. The risk adjustment program is designed…
