Anthem Blue Cross of California is bringing its controversial out-of-network penalty policy to California on June 1, a move that has already drawn legislative backlash in the insurer’s home state of Indiana. Under the policy, participating hospitals and facilities in…
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Spartanburg (S.C.) Regional Healthcare System is slated to go out of network with Aetna commercial and Medicare Advantage plans April 15, according to the system’s website. The health system said its misalignment with the insurer stems from their Medicare contract,…
CMS issued requests for applications from Medicare Part D plans and state Medicaid agencies to join the voluntary “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth,” known as BALANCE, model. Under the model, CMS will negotiate with manufacturers on…
L.A Care Health Plan is the largest Medicaid managed care organization in the U.S. with nearly 2.4 million enrollees, according to KFF. KFF used CMS data reflecting enrollment totals as of July 1, 2024 across the 42 states and Washington,…
Across hospitals, quality outcomes are often influenced by a relatively small number of patients with shared clinical and operational complexity. These micro-cohorts — defined by factors such as comorbidities, discharge pathways, infection risk or length-of-stay patterns — frequently drive disproportionate…
Apr 9, 2026 1:00 PM - 2:00 PM CDT
Presented by:
Presenter:
- Nik Rao, CEO, Dexur
West Virginia lawmakers proposed a bill in January that would require payers covering cancer chemotherapy to also cover scalp cooling. Scalp cooling can help prevent or limit hair loss during chemotherapy. Under HB 4089, along with the mandate, insurers would…
Point32Health is laying off approximately 100 employees, or 2.3% of its workforce. “We regularly review our organization to ensure our teams and department functions are optimally set up to deliver for our members and customers,” spokesperson for the company told…
Humana’s President and CEO Jim Rechtin was paid $18.8 million in total compensation in 2025, the insurer said in regulatory filings published March 6. CFO Celeste Mellet was the company’s highest-paid executive in 2025, earning $18.9 million in total compensation,…
Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list. Listings were compiled from job-seeker sites. 1. Albany (N.Y.) Medical Center seeks an assistance director of system payer contracting. 2.…
Across the country, 78% of states’ Medicaid beneficiaries, where applicable, were enrolled through a Medicaid managed care organization in 2024. KFF published the 2024 data showing percentages of the Medicaid population enrolled in managed care. KFF did not consider Idaho…