Today's Top 20 Stories

  1. What's new for ACA open enrollment: 5 notes

    Rylee Wilson -
    Open enrollment for individual plans on the ACA exchange runs from Nov. 1 to Jan. 15.  

  2. UnitedHealth closes acquisition of UK company

    Andrew Cass -
    UnitedHealth Group has completed its acquisition of health technology firm EMIS Group, according to an Oct. 27 EMIS Group news release. 

  3. OIG: Humana subsidiary received estimated $117M in overpayments in 2015

    Rylee Wilson -
    Humana subsidiary CarePlus Health Plans received $641,467 in net overpayments in 2015, an audit by HHS' Office of Inspector General published Oct. 26 found. 

The state of AI in healthcare

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  1. Centene launches co-branded Medicare Advantage plans with Mutual of Omaha

    Rylee Wilson -
    WellCare, Centene's Medicare Advantage subsidiary, will offer co-branded plans with Mutual of Omaha in 2024. 

  2. How Aetna snagged a multibillion-dollar state contract from BCBS North Carolina

    Jakob Emerson -
    Starting in 2025, Aetna will take over a three-year health benefits contract for more than 740,000 North Carolina state employees, public educators, retirees and their dependents, upending a 45-year relationship between the state and Blue Cross and Blue Shield of North Carolina. 

  3. Employers eye deductible-free plans

    Rylee Wilson -
    Employers are looking to deductible-free health plans as employees report increasing concerns about the cost of healthcare, according to Mercer's 2023-2024 "Inside Employees' Minds" survey. 

  4. Aetna adds 5 new exchange states for 2024

    Rylee Wilson -
    Aetna is expanding its ACA plans to five new states in 2024. 

How one Midwest hospital is driving financial efficiency with interconnected systems

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  1. CMS: Insurers to lose $1.1B in risk adjustment payments from Bright Health, Friday exits

    Rylee Wilson -
    Bright Health and Friday Health Plans are unable to meet their risk-adjustment payment obligations, leaving other insurers $1.1 billion short, CMS disclosed Oct. 27. 

  2. Private payer's prices highest in upper Midwest and Southeast, price transparency study finds

    Jakob Emerson -
    Payers' negotiated prices for office visits and medical services can vary widely from county to county, according to a price transparency study published Oct. 27 in JAMA Health Forum.

  3. Senators want to bust Medicare Advantage 'ghost' networks

    Rylee Wilson -
    Lawmakers are introducing a bill to crack down on inaccurate provider directories in Medicare Advantage. 

  4. Medicaid in the headlines: 7 recent updates

    Rylee Wilson -
    Insurers appointed new executives to lead their Medicaid business, and one CEO expects Medicaid expansion is around the corner in more states. 

How one Midwest hospital is driving financial efficiency with interconnected systems

Sponsored
Major time savers can stem from single logins. That's how 1 hospital achieved a 50% reduction in month-end close time — read the short case study, here.

  1. North Carolina treasurer urges state to drop weight loss drug coverage for employees

    Jakob Emerson -
    North Carolina's treasurer, Dale Folwell, is urging the board that oversees the state's employee health plan to end coverage for GLP-1 drugs such as Wegovy and Saxenda, citing high costs.

  2. Aetna plans another round of layoffs; 2023 cuts total 600

    Rylee Wilson -
    CVS Health is planning to lay off an additional 70 employees at Aetna, in addition to a previously announced round of layoffs. 

  3. Jefferson Health adds new Medicare Advantage offerings for 2024

    Rylee Wilson -
    Jefferson Health Plan will add four new plans in 2024. 

  4. Florida woman sentenced to 8 years in prison for $36M scheme to defraud Blue Cross Blue Shield

    Rylee Wilson -
    The lead defendant in a 15-defendant healthcare fraud scheme will serve over eight years in prison for conspiring to defraud Blue Cross Blue Shield. 

  5. Lawmakers look to ease Medicaid churn

    Rylee Wilson -
    A group of U.S. senators and representatives are introducing legislation to provide Medicaid enrollees with a year of continuous coverage. 

  6. Senators urge more action from CMS on misleading Medicare Advantage marketing

    Rylee Wilson -
    A group of senators says CMS actions to crack down on misleading marketing of Medicare Advantage plans do not go far enough. 

  7. Cambia appoints former Optum exec to lead government business

    Rylee Wilson -
    Cambia Health Solutions has named William Krenz as senior vice president of government programs. 

  8. Molina taps 2 execs to lead Medicaid business

    Rylee Wilson -
    Molina Healthcare is promoting two senior leaders to run its flagship Medicaid business, CEO Joe Zubretsky said on an Oct. 26 investor call. 

  9. 16% of adults considering dropping health insurance due to cost

    Rylee Wilson -
    Over half of U.S. adults say their healthcare costs are difficult to afford, including 43% of those with employer-sponsored insurance, a Commonwealth Fund survey published Oct. 26 found. 

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