Oscar Health reported a net loss of $228 million in the second quarter of 2025, compared to $56 million in net income during the same quarter last year, according to its Aug. 6 financial report. “Oscar is well-positioned to manage…
The Latest
Aetna is rolling out a new inpatient reimbursement policy for its Medicare Advantage and Special Needs Plans, effective Nov. 15. “Our goal is simple: We want to help you get reimbursed faster for inpatient admissions that are initially denied. You’ll…
Hospitals are racing to prepare for CMS’ TEAM model – and Prime Healthcare is already ahead. As the BPCI-A era ends, the shift to TEAM requires fast action: robust data systems, cross-continuum coordination and SDOH strategies that support equitable, episode-based…
Sep 4, 2025 12:00 PM - 1:00 PM America/Chicago
Presented by:
Presenters
Dr. Ahmad Imran
Vice President, Quality & Value-Based Care Prime Health Care
Dr. Mansoor Khan
CEO Persivia
Major insurers are retrenching their Medicare Advantage strategies as federal cost‑containment measures and rising medical expenses squeeze profitability. Amid the growing financial pressures the industry has faced for nearly two years, the largest MA carriers are cutting supplemental benefits, exiting…
In June, Cigna began launching a suite of new AI tools designed to help members better navigate their health benefits. The new features are being rolled out in phases on Cigna’s member portal, where enrollees will have access to an…
Health systems face a trifecta of challenges: post-pandemic burnout, workforce shortages and rising pressure to improve retention. At Advocate Health — created in 2022 through the combination of Atrium Health and Advocate Aurora Health — the solution wasn’t more perks.…
Sep 18, 2025 2:00 PM - 3:00 PM America/Chicago
Presented by:
Presenters
Suzanna J. Fox, MD
Executive Vice President and Chief Physician Executive Advocate Health
James Gilligan
Vice President Health Systems and Group Partnerships, AMA
UnitedHealthcare is expanding cancer detection benefits for some commercial members in 2026. Some UnitedHealthcare fully insured plans will now cover the first diagnostic breast imaging, colorectal cancer detection service, and colonoscopy at any age and at no cost when recommended…
The One Big Beautiful Bill Act has the potential to significantly reshape coverage and reimbursement. Early indicators are already prompting some health systems to brace for rising self-pay patient volumes and a shifting payer mix — signals that broader disruption…
Sep 23, 2025 11:00 AM - 12:00 PM America/Chicago
Presented by:
Presenters
Nicole Fountain
Vice President, Revenue Cycle, UChicago Medicine
Shannon Cameron
Chief Operating Officer, Revenue Cycle, AFS, LLC of Harvard Medical Faculty Physicians
Jamie Davis
VP Revenue Cycle, SSM Health
Sarah Brainard
Vice President of Enterprise Solutions, Office Ally
CMS is proposing a five-year experiment that would allow state Medicaid programs and Medicare Part D plans to cover GLP-1s for weight management on a voluntary basis, according to an Aug. 1 report from The Washington Post. Ozempic, Wegovy, Mounjaro…
Hospital-acquired conditions are a significant issue, affecting 1 in 10 hospitalized adults in the U.S. Specifically, pressure injuries acquired in the hospital come at a considerable cost to patient health and hospital financial performance, adding $21,767 per patient. Left unchecked,…
Presented by: