Today's Top 20 Stories
  1. 6 months after splitting, Community Health System is back in network with 3 major payers

    Clovis, Calif.-based Community Health System is back in network with Anthem Blue Cross Blue Shield after a split lasting six months.
  2. Budget battle could delay North Carolina's Medicaid expansion

    Squabbles over the state's budget could delay implementation of Medicaid expansion in North Carolina.
  3. Anthem BCBS, Maine hospitals ink in-network contract

    Anthem Blue Cross Blue Shield and two hospitals in Maine operated by Tewksbury, Mass.-based Covenant Health have reached an in-network agreement.

The No-Surprises approach to the No Surprises Act: Tips for payer success

Payers, it's time to demystify the No Surprises Act. Experts share tips for success + best practices for member support in this discussion.
  1. How Elevance Health achieved a 20% drop in suicide rates among young people

    Elevance Health has achieved a drastic reduction in youth and young adult suicides through predictive modeling and clinical outreach.
  2. Idaho drops Optum, awards $1.2 billion behavioral health contract to Centene

    Idaho has dropped Optum as the managed care contractor for its behavioral health plan and awarded a four-year, $1.2 billion contract to Centene's Magellan Healthcare subsidiary.
  3. 10 providers seeking payer contracting talent

    Ten providers recently posted job listings seeking leaders in payer contracting and relations.
  4. Kraft Heinz sues Aetna for alleged claims data mismanagement

    A Kraft Heinz Co. employee benefits group representing employees, retirees and their dependents is suing Aetna for allegedly breaching its fiduciary duties and using its role as third-party claims administrator "to enrich itself to Kraft Heinz's detriment."

The key to unlocking business value for payers? A better member experience

Satisfied customers are 5x more likely to renew their health insurance. Execs from Highmark Health, McKinsey & more share strategies for keeping members happy and boosting revenue in this free e-book.
  1. Prime Therapeutics names new CEO

    Prime Therapeutics has promoted Mostafa Kamal to be the pharmacy benefit manager's next CEO.
  2. Medicare Advantage profits could be under pressure in 2024, analysts say

    Medicare Advantage profits will likely be stable in 2023 but could face pressure from rising utilization rates in 2024, according to commentary from AM Best published June 30.
  3. Medicare Advantage in the headlines: 7 recent updates

    New regulations for inpatient services in Medicare Advantage are looming, and new research has found MA enrollees with chronic conditions are likely to stay enrolled in the programand spend less time in the hospital than their fee-for-service counterparts.
  4. States with the largest employee health plans

    State employee health plans are often the largest commercial purchaser of healthcare in each state, according to a report from the Center on Health Insurance Reforms at Georgetown University in Washington, D.C.

The 3 steps to fix your denials issue + strengthen patient access

Increased denials are more than a headache — they're a big obstacle to your patients' well-being. These 3 steps can get you over the hurdle. Watch now.
  1. CMS updates Medicare drug price negotiation guidelines

    CMS published updated guidance for the Medicare Drug Price Negotiation program, based on feedback from more than 7,500 public comments.
  2. Medicare Advantage enrollees less likely to receive risky medications: Study

    Medicare Advantage members are less likely to be prescribed high-risk medications than their counterparts in fee-for-service Medicare, a study published June 27 in JAMA Health Forum found.
  3. Retiring Centene exec appointed to Homeward board

    Longtime Centene executive Brent Layton is joining the board of directors for healthcare startup Homeward.
  4. Independence Blue Cross names three new vice presidents

    独立蓝十字促进了丹尼尔·布朗to vice president of provider reimbursement analysis and administration, Michael Hébert to vice president of provider contracting, and Obadiah Sang to vice president of corporate development and strategic investments.
  5. Molina to acquire Bright Health's Medicare Advantage business in $600M deal

    Molina Healthcare will purchase Bright Health Group's California Medicare Advantage business for $600 million, the two businesses said June 30.
  6. Health insurance executive moves | 2023

    Payer executive moves reported by Becker's in 2023:
  7. Percentage of Medicaid recipients disenrolled for procedural reasons in 22 states

    A minimum of 80 percent of Medicaid beneficiaries disenrolled from the program were booted for procedural reasons in nine states, according to a June 29 report from KFF.
  8. BCBS Arizona launches primary care subsidiary

    Blue Cross Blue Shield of Arizona has launched a new primary care company, Prosano Health Solutions.
  9. What makes the health plans top-rated by their members unique? 8 executives explain

    Satisfaction with commercial health plans is on the decline, especially among younger generations, according to J.D. Power's 2023 Commercial Member Health Plan study.

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