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1. Trump pledges $500 checks to 1 million people for ACA ‘overcharges’ Full story
2. Optum Insight names Amazon alum as chief AI officer Full story
3. GLP-1s are reshaping pharmacy economics for every health plan, ICHRA is changing the employer-sponsored market, and direct contracting is shifting the network model. All three are on the agenda Nov. 2-3 in Chicago. Apply to attend Becker’s Fall Payer Issues Roundtable as a reviewer here.
4. Centene’s Health Net faces sanctions threat as it winds down some services for Medi-Cal members Full story
5. 30 health systems dropping Medicare Advantage plans Full story
6. Highmark’s sales enablement VP on turning employer data into stronger renewals here.
7. Dignity sues Medi-Cal plan, claiming $30M in unpaid bills Full story
8. 12 recent payer fines from states Full story
9. ‘We’re here for the long term’: Michigan payer doubles down on Medicare Advantage as others retreat Full story
10. Plan switches for dually eligible MA members increasingly common Full story
11. The 20 most expensive conditions hospitals treat: Report Full story
12. Payment integrity leaders no longer have to trade audit quality for scale. See why here.
Becker’s Learning Opportunities
13. A cancer misdiagnosis caught early saved one plan $174,000. See how here.
14. Risk adjustment without the annual scramble: See why perspectives from informatics and actuarial teams help — in this webinar.
15. Telligen is rebuilding medical necessity review with AI and clinical oversight here.
16. Becker’s September webinar lineup: hospital AI, nonopioid pain care and analytics governance. See the sessions here.
Apply to attend complimentary as a guest reviewer here! Opportunity exclusive to those directly employed by a payer, payvider, accountable care organization, or clinically integrated network.
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