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A real-time data initiative helped Healthfirst improve follow-up rates for patients visiting emergency rooms for mental health and substance use…
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A real-time data initiative helped Healthfirst improve follow-up rates for patients visiting emergency rooms for mental health and substance use conditions. A national challenge for the industry is that relying on claims data alone is not fast enough to ensure…
Several major health systems and insurers are going out of network on July 1. Contract disputes between insurers and health systems are down in 2025 compared to the second half of 2024. In the first quarter of 2025, 26 total…
What 100 Health Plan Executives Say About Network Design, Data Gaps and Regulatory Pressure
During a featured session at Becker’s 3rd Annual Payer Issues Roundtable, Bob Tavernier, Sales Solutions Executive with Quest Analytics®, and Karen Tachian, Senior Director of Network Regulatory Operations with Health Care Service Corporation, unpacked recent survey data from 100 health…
The Cigna Group is granting 24 health organizations funding to support youth mental health projects. Here are three things to know: See the full list of grantees here.
Blue Shield of California is cutting broker commissions for new enrollments into Medicare Advantage PPO plans in Alameda, Orange and San Diego counties, effective July 1. The new policy does not affect commission payments of existing membership, according to a…
Wisconsin Physicians Service Insurance Corporation is laying off 51 employees in Madison and Monona due to competitive pressures. The layoffs will begin to take place on Sept. 30, according to regulatory documents filed with the state June 27. Madison-based WPS…
Federal lawmakers have introduced a handful of bills aimed at speeding up prior authorization and cracking down on upcoding in Medicare Advantage. None of the introduced bills have been heard in committee. Here are five proposals introduced in 2025 to…
In June, more than 50 insurers agreed to a set of voluntary actions aimed at simplifying the prior authorization process. The group of insurers, backed by leaders including CMS Secretary Mehmet Oz, MD, said they will work to implement a…
A new peer-reviewed study analyzed real-world data from patients of a large, risk-bearing provider, who were also covered by one of New Jersey’s largest health plans. It found that a non-invasive, home-based treatment for knee and back pain reduced musculoskeletal…
Amar Desai, MD, is out as CEO of Optum Health, Bloomberg reported June 26. Patrick Conway, MD, CEO of Optum, will also take over as CEO of Optum’s health division, Bloomberg reported, citing an internal memo. Dr. Desai will remain…