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AI could help hospitals lower costs, but Fitch said those savings could prompt payers and policymakers to reprice reimbursement. The…
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The California Medical Association and the California Association of Health Plans are challenging the state’s restructured managed care organization tax, according to an Oct. 1 California Supreme Court filing. The legal action is directed at California’s Department of Health Care…
CMS is raising concerns about growing costs and payment problems in the federal independent dispute resolution process created by the No Surprises Act and met with every certified independent dispute resolution entity Oct. 1 to talk about possible changes. CMS…
Ask a health plan executive what they want AI to do, and they’ll usually answer with a goal, faster credentialing, cleaner directories, fewer complaints. But AI isn’t the goal. It’s one way to get there, and for most of what…
Presented by:
- Chris Lance, Chief Product Officer, Quest Analytics®
- Adam Sullivan, VP of AI, Change Healthcare, Labcorp
As insurers pivot their market and product strategies, executive leadership has been evolving at health plans and their parent companies. Here are 28 health plan leadership moves to know from the second half of 2026:
New Jersey Democratic Gov. Mikie Sherrill launched the State Health Benefits Program Reform Working Group on Oct. 1 to review and advise on health coverage for public employees. Ms. Sherrill announced the working group following a Sept. 2 agreement with…
Five Democratic governors have asked HHS Secretary Robert F. Kennedy Jr. to delay the Jan. 1, 2027, compliance date for Medicaid work requirements, stating that they cannot implement the rules responsibly in the fewer than 100 days that remain. The…
By the time MLR pressure shows up in your numbers, the margin may already be locked into the quarter. The question is whether you’ll spot the signals early enough to change the outcome. Most health plans don’t recognize margin pressure…
Presented by:
- Stewart Hinrichsen, Senior Director, Value-Based Strategy, Martin's Point
- Raj Lakhanpal, Chief Executive Officer, SpectraMedix
- Sean Kelly, Senior Vice President, Growth and Business Development, SpectraMedix
- Charles Chervitz, Consultant, SpectraMedix
A Clover Health July data breach affected 138,677 people, according to a notice filed with HHS’ Office for Civil Rights. Clover flagged the incident to the Securities and Exchange Commission on July 17 after first learning of unauthorized activity on…
The Department of Veterans Affairs has awarded Optum Serve a 10-year contract worth up to $30 billion to build and administer its national dental network. The network is set to be fully in place within a year of the award…
Medicare Advantage insurer Devoted Health has closed a $555 million Series G round as part of a $1.18 billion financing deal. The remainder is a $622 million commitment from the same investors to buy shares from existing Devoted shareholders through…
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How CareSource Indiana reached 90th-percentile follow-up performance for high-need members
Presenters: Kristi Carney, Indiana MarketNishi Rawat, MD, Bamboo Health
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