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Physicians with higher-risk patient populations less likely to be included in Medicare Advantage networks: Study
Physicians who serve more patients dually eligible for Medicare and Medicaid and with higher risk scores are less likely to be included in Medicare Advantage networks, a study published July 21 in JAMA Health Forum found. -
Integrated pharmacy benefits can save members $400 a year, BCBS Minnesota report finds
Employer-sponsored insurance plans with fully-integrated medical and pharmaceutical benefits can lower medical costs and reduce hospitalization and emergency room visit rates, according to a report from Blue Cross Blue Shield of Minnesota and Prime Therapeutics. -
Acquitted LifeBrite CEO sues 6 payers for $1B over alleged 'smear campaign'
The CEO of a laboratory company acquitted in a $1.4 billion fraud scheme is suing six payers, alleging they made false allegations to regulators and prosecutors to avoid paying millions in legitimate claims. -
Elevance Health in the headlines: 9 recent updates
Elevance Health beat investor expectations in its latest earnings report and is adding new food-as-medicine initiatives. -
Medicare Advantage enrollees living in disadvantaged neighborhoods more likely to use high-cost care: Study
The neighborhood an individual lives in can affect their healthcare utilization, especially in the Medicare population, according to a study in the American Journal of Managed Care. -
Some providers concerned California's historic Medicaid funding increases won't last
Some healthcare industry leaders are pushing to make California's largest-ever investment in Medi-Cal permanent, KFF Health News reported July 21. -
Aledade and payers: 4 updates
Value-based physician platform Aledade has partnered with several of the nation's largest payers over the last year. -
4 recent prior authorization updates
From the HHS Office of Inspector General raising concerns over denial rates to Health Care Service Corporation expanding its use of AI technology, here are four updates on prior authorization reported by Becker's since July 13: -
5 Medicare Advantage plans audited for upcoding in 2023
Audits from HHS' Office of Inspector General published in the first half of 2023 found over $56 million in estimated overpayments to Medicare Advantage providers. -
Medicaid in the headlines: 7 recent updates
As of July 19, more than 3 million people have been disenrolled from Medicaid during the unwinding of the Medicaid continuous enrollment provision, according to KFF. -
Elevance Health: GLP-1 drugs just 'one element' of rising costs
Expensive GLP-1 drugs are just one of many factors driving up medical costs, Elevance Health CFO John Gallina said. -
3 ways Elevance Health is using AI
Elevance Health is scaling new uses for artificial intelligence. -
Prior authorization denial rates for 7 payers' Medicaid MCOs
Molina Healthcare had the highest overall prior authorization denial rates in 2019 among the seven largest Medicaid managed care organizations, according to an audit from HHS' Office of Inspector General. -
CMS halts Medicaid redeterminations in 'half-dozen states'
CMS has required around a half-dozen states to pause procedural terminations to correct errors through the Medicaid redetermination process, CMS officials told reporters on a July 19 press call. -
Elevance Health loses 135,000 Medicaid members in 1st months of redeterminations
Elevance Health is expecting many members who have lost Medicaid to transition to other forms of coverage, executives told investors on a second-quarter earnings call. -
California's state employee health plan premiums to increase by 11%
California's health plan costs for state employees and retirees are rising at an "unsustainable" rate, state officials said. -
Medicaid managed care organizations deny 1 in 8 prior authorization requests: OIG
HHS' Office of Inspector General raised concerns about the rate of prior authorization denials in Medicaid managed care and a lack of state oversight of these denials in an audit published July 17. -
Elevance Health posts $1.9B profit in Q2
Elevance Health posted double-digit revenue growth and beat investor expectations in the second quarter of 2023, according to the company's earnings report published July 19. -
California Medical Association can sue Aetna over its referral policy, court rules
The California Supreme Court ruled that the state's medical association has standing to sue Aetna's operations in California for allegedly interfering with the medical judgment of physicians who refer patients to out-of-network providers. -
The 9 highest paid CEOs at publicly traded health insurance companies | 2022
The following leaders were the nine highest paid chief executives at publicly traded health insurance companies in 2022, according to public financial filings.
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