Payer

Health plans must do a better job of educating members about their benefits and costs while shifting from focusing on compliance around price transparency to member engagement. While digital tools are increasingly important, providers must continue to offer traditional engagement…

SCAN Health Plan has won its lawsuit against CMS that claimed the agency improperly calculated the payer's 2024 Medicare Advantage star rating.

A former AstraZeneca executive is facing federal cyberstalking charges for allegedly sending violent threats to executives at CVS Health and Aetna following issues with personal claims reimbursements, according to a criminal complaint filed May 8 in a Delaware federal court.

Cigna's Evernorth Care Group plans to cut specific specialty services and consolidate certain Arizona care locations in the next few months. The reductions will result in 261 employees being laid off, according to an Arizona WARN notice filed May 31. 

Blue Cross and Blue Shield of Kansas City is exiting the Medicare Advantage market at the end of 2024, citing increasing regulatory requirements and financial headwinds. 

In less than a month's time, a federal lawmaker warned weight loss drugs have the potential to bankrupt the healthcare system, and new research from Blue Cross Blue Shield found nearly six in 10 patients taking the drugs don't reach…

Claims adjudication is a complex process with rising costs. Solutions involve a combination of automation, selective outsourcing and process optimization to lower costs and improve efficiency.

Iowa and Nebraska have the highest percentage of original Medicare enrollees with supplemental benefits, while Hawaii has the lowest, according to an AHIP report published in May.

UnitedHealth Group is running around 500 use-case applications for AI across the organization, CEO Andrew Witty told investors. 

Redeterminations could be shaking up margins in the Medicaid business, payer executives warn.