Chronic inflammatory conditions drive high drug spend — and poor adherence often leads to costly flares, ER visits, and hospitalizations. Gaps in patient engagement, prescriber coordination, and side effect management make sustained adherence difficult. This whitepaper introduces a nurse-led pharmacy…
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AmeriHealth Caritas, a managed care organization, is growing its Medicare Advantage offerings, focusing on its Medicare-Medicaid dual-eligible special needs plans, according to a news release shared with Becker’s. In 2026, the insurer’s MA dual-eligible offering will be available in new…
Stronger CPR skills, fewer disruptions: How Trinity Health Muskegon redefined resuscitation training Traditional CPR certification models often leave clinicians unprepared. Skills can fade just 90 days after training, and high staff turnover only undermines teamwide competency. Trinity Health Muskegon tackled the problem head-on. After shifting to a quarterly, low-dose CPR training program,…
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The National Committee for Quality Assurance has named Vivek Garg, MD, as its next president and CEO, effective Jan. 5. Dr. Garg succeeds NCQA founder and current president Margaret O’Kane, who will retire at the end of this year. He…
Work requirements for Medicaid eligibility are set for 2027, but states can request short-term exceptions for counties with high unemployment. By assessing county-level data in Medicaid expansion states, KFF found only 7% of counties meet the exception criteria using a…
UnitedHealth Group has asked a Minnesota federal court to throw out a proposed class action lawsuit filed against it by the country’s largest pension fund. The lawsuit, originally filed by the California Public Employees’ Retirement System (CalPERS) in May 2024 and…
With the release of CMS Star Ratings for 2026 and updates for the upcoming year, Medicare Advantage and Part D plans are navigating an evolving quality landscape. Adherence measures are shifting from triple- to single-weighted and will incorporate risk adjustment,…
Average premiums, benefits and plan choices for Medicare Advantage and the Medicare Part D prescription drug program should remain relatively stable next year, CMS said in a Sept. 26 news release. But MA enrollment is projected to decrease 900,000 in…
Commercially insured patients pay substantially different rates for the same procedure, with negotiated costs for inpatient procedures varying by an average ratio of 9.1, according to an August report from market intelligence firm Trilliant Health. The report reviewed health plan…
An estimated 3 out of 5 U.S. children have been enrolled in Medicaid or the Children’’s Health Insurance Program, according to a Harvard T.H. Chan School of Public Health model. As of 2024, states must provide a year of continuous…