The Latest - Page 321 of 1589 - Becker's Payer Issues

Modernizing and Redefining UM: How health plans can lead amid changing demands

Payers face growing pressure to modernize utilization management. Between rising provider abrasion, evolving expectations from AHIP and CMS, and intensifying market competition, traditional UM strategies no longer cut it. In this on-demand session, you’ll learn what the AHIP-CMS pledge signals…

On Demand

Presented by:

Presenters:

Gus Weber, Chief Technology Officer, Cohere Health
Ashok Subramanian, Chief Executive Officer, Centivo
Geoff Swanson, Chief Medical Officer, Select Health
Pooja Ika, President & CEO, Eternal Health
Ty Wang, Co-Founder & CEO, Angle Health

Register

Molina sued by investor over undisclosed care costs

Molina Healthcare is facing a proposed class-action lawsuit from an investor who alleges the company misled shareholders about rising medical costs and its 2025 earnings projections. The complaint, filed Oct. 3 in the U.S. District Court for the Central District…

AHA questions MedPAC finding that Medicare Advantage growth hasn’t hurt hospital finances

The American Hospital Association critiqued the Medicare Payment Advisory Commission’s initial assessment of Medicare Advantage enrollment changes and its effect on hospital finances, according to an Oct. 3 letter from Molly Smith, AHA’s group vice president of public policy. MedPAC…

Viewpoint: Vertically integrated insurers can exploit MLR rules

Insurers that own providers can use internal transactions to inflate medical spending figures and reduce their rebate obligations under the ACA’s medical loss ratio rules, according to an analysis published Sept. 29 in Health Affairs. The analysis was published by…

Federal judge rules for Elevance in age discrimination lawsuit

A federal judge in Washington state ruled in favor of Elevance Health in a case involving a former executive who was accused of violating a relationship policy and was terminated, according to an Oct. 3 order granting a motion for…

2 leaders join Premera board

Caroline Goldzweig, MD, and Betsy Seaton joined the board of directors for Premera — parent company of Premera Blue Cross — according to an Oct. 6 news release. Dr. Goldzweig is the vice president and chief medical officer for the…

Is pharmacy labor your biggest cost driver? This pharmacy cut $625K per month

Technician turnover is above 30%, labor costs are rising, and prescription volumes are projected to grow 10–12% by 2028. Traditional, manual pharmacy models simply can’t keep up. One pharmacy needed 862 FTEs to process 75,000 daily prescriptions manually. With automation?…

Presented by:

Download

UnitedHealthcare calls out healthcare groups' 'cynical' contract negotiation strategy

UnitedHealthcare’s Mid-Atlantic CEO Joseph Ochipinti called out two healthcare groups for their “cynical” contract negotiation strategy in an Oct. 6 statement. Mr. Ochipinti specifically drew attention to Baltimore-based Johns Hopkins Medicine and Fulton, Md.-based Capital Women’s Care, a large mid-Atlantic…

Sentara pulls back from Medicare Advantage, laying off 200+

Sentara Health Plans will not offer Medicare Advantage, MA prescription drug HMO, or C-SNP plans in Virginia, North Carolina and Florida in 2026. “These products are no longer financially sustainable in the current environment. Industry-wide headwinds and market dynamics, including…

Duke Health, Aetna finalize multi-year contract

Durham, N.C.-based Duke Health will stay in network with CVS Health’s Aetna, according to an Oct. 3 statement on the university system’s website. The agreement allows Aetna’s commercial and Medicare Advantage members to access all Duke Health locations and providers.…