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St. Louis-based Mercy and Humana have opened two joint primary care clinics for older adults. The first two clinics in…
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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…
Payers are trimming their workforces and cutting jobs due to financial or operational challenges, along with contract losses.
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…
Payers have faced state penalties in 2025 for slow reimbursements, improper claims denials, and mental health parity violations. Fines in 2024 are here. Payers fined by states in 2025:
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…
UnitedHealth Group and Optum have settled a lawsuit filed by two former employees who had alleged that the company violated state and federal employee notification laws during mass layoffs in August 2023. The lawsuit, filed in the District Court for…
Cigna is launching a suite of AI tools designed to help members navigate their health benefits. The new features are being rolled out in phases on Cigna’s member portal, according to a June 12 news release. Here are four things…