The broader health insurance industry has announced a series of commitments to streamline, simplify and reduce prior authorization requirements across commercial, Medicare Advantage and managed Medicaid plans covering 257 million Americans. “The health care system remains fragmented and burdened by…
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New York City Mayor will not implement an Aetna Medicare Advantage plan for its retirees, Mayor Eric Adams said June 20. “We have heard concerns from retirees about these potential changes at numerous older adult town halls and public events,…
At Becker’s 15th Annual Meeting, leaders from Microsoft and Blue Shield of California shared how AI is one tool to help transform payer operations — not by replacing humans, but by personalizing care, cutting friction and restoring trust. Christine McKinney,…
From exploring the sale of a South American-based subsidiary to suing The Guardian for defamation, here are 10 updates on UnitedHealth Group that Becker’s reported since June 2: 1. A federal judge approved a $69 million agreement to settle a…
New York City can implement an Aetna Medicare Advantage plan for its retirees, the state’s highest court ruled June 18. The city has pushed to switch its health benefits for retired city employees to a Medicare Advantage plan since 2021.…
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Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list. Listings were compiled from job-seeker sites. 1. CentraCare, based in Saint Cloud, Minn., seeks a senior director of payer contracting…
How to Build a Technology-First Strategy for UM Effective utilization management (UM) begins with a strategic approach grounded in technology, data, and continuous improvement. As AI adoption accelerates, payers must align their UM strategies with both regulatory demands and operational…
Uncertainty around potential pharmaceutical tariffs is one factor driving up the cost of marketplace coverage in 2025, according to KFF. Multiple insurers, including UnitedHealthcare plans in New York, Maryland and Oregon, and Independent Health have cited tariffs on pharmaceuticals as…
Health system executives are under growing pressure to manage tighter margins, navigate shifting reimbursement models and cultivate strong payer relationships. At the same time, unprecedented volumes of pricing data are becoming available, offering health systems a new source of insight…
The gap in out-of-pocket spending between Medicare Advantage and fee-for-service beneficiaries is widening, according to a report from the Better Medicare Alliance. The pro-Medicare Advantage group, backed by major insurers, commissioned the analysis, which was conducted by ATI Advisory. The…