Aetna is rolling out new claims cost control measures under its Claim and Code Review Program, beginning Sept. 1. The new claims editing policy applies to commercial, Medicare and student health members, the company said in June. Aetna may trigger…
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Delayed wound care drives avoidable costs — and for payers, those costs can be substantial. Each year, U.S. health plans spend billions on wound-related treatment, complications and prolonged care episodes. New real-world data from more than 15,000 patients shows how…
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Economic uncertainty and policy changes from the current administration have changed the way health plans operate over the past year. Many have found workarounds to continue efficiency and growth. Becker’s connected with five leaders to learn their biggest accomplishments so far…
MVP Health Plan has agreed to overhaul its mental health provider directory as part of a settlement with the New York Attorney General’s Office. The settlement follows an investigation from the office that uncovered systemic issues with MVP’s network, including…
Massachusetts has approved $75.6 million in health insurance rebates for more than 350,000 residents and small businesses. The rebates are required under the state’s medical loss ratio law, which mandates that insurers spend at least 88% of premiums on medical…
With almost half of healthcare executives prioritizing data and analytics, systems are not just collecting data — they’re using it to surface cost drivers, guide investment decisions and shift enterprise mindsets. But many health systems are still stuck in reactive…
Sep 26, 2025 1:00 PM - 2:00 PM CDT
Presented by:
Presenters:
- Dan O’Donnell, Director, Technology & Digital, Point B
- Tory Tolton, Senior Vice President, Technology & Digital, Point B
- Mark W. Lodes, MD, Chief Medical Officer, Population Health and Medical Education, Froedtert & the Medical College of Wisconsin
- Stacy Zoucha, Director of Digital Health and Innovation, Children's Nebraska
- Amber Price, DNP, CNM, MSN, RN, SVP, Enterprise Chief Nursing Officer, Sentara
The Justice Department has expanded its criminal investigation into UnitedHealth Group, examining the company’s pharmacy benefit manager, Optum Rx, and how it compensates its employed physicians, Bloomberg reported Aug. 26. The probe now goes beyond the previously reported potential Medicare…
AI is no longer an emerging idea in healthcare. It’s being tested and scaled across the care continuum. But what’s actually working? This session breaks down three real-world AI use cases in healthcare that have produced measurable results. Advisory Board…
Sep 29, 2025 11:00 AM - 12:00 PM CDT
Presented by:
Presenter:
- Ken Weitzel, Director, Research delivery and expert partner, Advisory Board
Labor costs remain the largest expense for hospitals, yet many teams still make staffing decisions without timely, reliable data. Premium pay, overtime and agency use surge when leaders can’t see demand signals in real time or match the right clinician…
Oct 7, 2025 11:00 AM - 12:00 PM CDT
Presented by:
Presenter:
- Thomas Lanvers, Senior Vice President, Locumsmart
Blue Shield of California has named Mike Stuart as permanent president and CEO. Mr. Stuart has served as the company’s CFO since 2022, according to an Aug. 26 Blue Shield of California news release. He has also served as interim…