Tension between providers and managed care organizations is no secret. MCO scrutiny and provider hesitancy around value-based care are among the challenges. Earlier this month, behavioral health-focused Magellan Health appointed Steven Pratt, MD, as chief medical officer. He sat down…
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Louisiana’s Office of Group Benefits is cutting back its reliance on CVS Caremark as its pharmacy benefit manager for state employees, according to Sept. 18 meeting documents. Liviniti and SilverScript Insurance Co., under CVS Health, are now forging emergency contracts…
Aetna is expanding a program that aims to reduce readmissions for its Medicare Advantage members to ten hospitals by the end of 2025. The insurer is currently implementing the clinical collaboration program at Merriam, Kan.-based AdventHealth Shawnee Mission, Houston Methodist,…
Traditional claim processing is plagued by interoperability issues, leading to manual data exchange and lack of transparency. Real-time, automated data exchange between health plans and providers can help. By sharing eligibility, claim and payment data upfront, providers can identify and…
The National Committee for Quality Assurance has once again named the highest-quality and most effective health plans in the country, with Blue Cross Blue Shield of Massachusetts remaining at the top. On Sept. 16, the NCQA released its 2025 ratings…
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As Medicare Advantage directory data are incorporated into the Medicare plan finder, CMS is launching a special election period for beneficiaries to leave their current plan if incorrect information is present, a Sept. 12 CMS memo said. This window applies…
From a judge denying a bid to limit discovery in an AI denial case to boosting lobbying efforts, here are 10 headlines about UnitedHealth Group and its subsidiaries that Becker’s has reported on since Sept. 5: 1. Senate and House…
Patients who get primary care from older adult-focused, value-based care organizations are more likely to use these services regularly, according to a study published in NEJM Catalyst: Innovations in Care Delivery, a digital journal published by The New England Journal…
A woman is suing Elevance Health after being denied coverage for Zepbound — Eli Lilly’s weight-loss drug — to treat her sleep apnea, a court filing said. According to the complaint, the FDA approved Zepbound “as the first and only…
Blue Cross Blue Shield of Massachusetts has hired Sophie Clarke, MD, as chief strategy officer and senior vice president, according to a Sept. 18 news release. Dr. Clarke’s role will focus on corporate strategy, along with identifying companies to fund…