Leadership

Health plans often prioritize managing high-cost areas like pharmacy, behavioral health, and diabetes while overlooking Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). This oversight results in unmanaged costs, leading to care delays, poor member experiences, and missed opportunities for…

The CEO of the nation's largest public health plan plans to keep advocating for Medicaid funding in retirement. 

Just two Medicare Advantage plans received five-star ratings from the National Committee for Quality Assurance for 2024. 

Payer executives are keeping a close eye on a shifting regulatory environment and ongoing provider shortages. 

Resistance to change is the biggest barrier to value-based care, Monica Engel, senior vice president of Government Markets at Blue Cross Blue Shield of Minnesota, told Becker's. 

Medicare Advantage plans "lacking substance" will not stand the test of time, Jordan Reigel, president of Essence Healthcare, told Becker's. 

Healthworx, CareFirst Blue Cross Blue Shield's investment arm, aims to bridge the gap between an established insurer and scrappy startups, Managing Partner Doba Parushev said. 

Primary care clinics focusing mainly on older adults are more likely to serve Black patients and those dually eligible for Medicare and Medicaid, a study from Humana found. 

Cybersecurity threats and rising costs are some of the greatest challenges facing payers and accountable care organizations, according to executives. 

Clover Health does not have direct competitors, CFO Peter Kuipers says.