Medicare Advantage enrollees receive fewer home health visits than their counterparts in fee-for-service Medicare, according to the Medicare Payment and Advisory Commission. The commission, which advises Congress on Medicare and Medicaid issues, published a report to Congress June 12. Here…
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UnitedHealthcare and Providence, R.I.-based Brown University Health have mutually agreed to go out of network on July 1 for Medicare Advantage plans. Brown’s hospitals in Rhode Island will be out of network for UnitedHealth’s MA plans, including D-SNP and group…
Medicare Advantage isn’t living up to its promise, Former U.S. Rep. Jim Greenwood wrote in an op-ed published in The Hill June 15. Mr. Greenwood was one of the authors of the Medicare Modernization Act of 2003, which created the…
HHS officials ordered CMS to provide the personal data of Medicaid enrollees to the Department of Homeland Security in June, according to an exclusive report from the Associated Press. The shared data includes the immigration status of Medicaid enrollees in…
St. Louis-based Mercy and Humana have opened two joint primary care clinics for older adults. The first two clinics in Springfield, Mo., and Nixa, Mo., opened in June, according to a June 12 news release. The clinic sites will be…
The federal government will spend an estimated $86 billion on Medicare Advantage supplemental benefits in 2025, according to a report from the Medicare Payment and Advisory Commission. MedPAC, which advises the federal government on Medicare policy, published the report to…
Chapel Hill-based UNC Health has filed lawsuits against Aetna and Humana, alleging both insurers underpaid for 340B drug claims in violation of their contractual agreements. The lawsuits, filed June 10 in a North Carolina federal court, claim the payers improperly…
Generative AI Pioneering the Future of Utilization Management The healthcare industry is rapidly positioning Generative AI (GenAI) at the forefront of Utilization Management (UM) reform. Far from being a speculative technology of the future, GenAI is here to transform stagnant…
Congress is tasked with making decisions that affect health coverage for millions of Americans — but what kind of insurance do lawmakers have? Senators are weighing the “One Big Beautiful Bill,” a sweeping budget package. According to the Congressional Budget…
Humana is taking proactive steps to address burnout and improve engagement for its thousands of employed or affiliated clinicians by focusing on well-being, reducing turnover, and tackling frustrations related to technology and administrative processes, according to the company’s Chief Medical…