Timeline — Competitive / Operational Strategy
Signals in this topic on one timeline — one payer bubble row apiece, all in this topic's color.
38 signals in the last 30 days
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A tale of 2 retailers: What drives success for co-branded Medicare Advantage plans
In August, SCAN Health Plan announced a partnership with Costco Wholesale Corp. to sell insurance products for older adults. Sound familiar? Costco is not the first retailer to partner with a Medicare Advantage insurer. Kroger has worked with Select Health and Priority Health on co-branded MA plans in 2023 and 2024. Websites outlining Select Health […] The post A tale of 2 retailers: What drives success for co-branded Medicare Advantage plans appeared first on Becker's Payer Issues | Payer Ne...
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Trump Administration Announces $76 Million to Strengthen Regional Coordination and Modernize Healthcare Technology for New York
Trump Administration Announces $76 Million to Strengthen Regional Coordination and Modernize Healthcare Technology for New York This federal investment will strengthen regional partnerships, improve coordination of care, and expand access to healthcare services for rural New Yorkers
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Trump Administration Invests $25 Million to Modernize Healthcare Technology, Expand Telehealth, and Improve High-Speed Internet Connectivity Across Michigan
Trump Administration Invests $25 Million to Modernize Healthcare Technology, Expand Telehealth, and Improve High-Speed Internet Connectivity Across Michigan This federal investment will help expand access and upgrade technology so doctors and patients can better connect and coordinate care across Michigan
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STAT+: Top Boston hospitals clash over Medicare Advantage network after split
First, Mass General Brigham split with Dana-Farber. Now its Medicare Advantage plan is dropping the cancer hospital.
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Scan.com raises $220M to expand US medical imaging network
The company plans to use the funding to further expand its U.S. network of imaging providers, as well as invest in its API and agentic AI infrastructure.
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IBX expands subsidized degree opportunities for employees
Independence Blue Cross is expanding its professional development opportunities for employees through a new partnership with Reading, Pa.-based Alvernia University. According to a Sept. 1 news release, the IBX University Partnership Deferral Program allows eligible employees to pursue undergraduate and graduate degrees with tuition support: an annual allowance of $5,250. Payments are deferred until an […] The post IBX expands subsidized degree opportunities for employees appeared first on Bec...
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Louisiana’s Medicaid contract with Elevance-BCBS venture to end, affecting 290,000
The Louisiana Department of Health’s Medicaid managed care contract with Healthy Blue, formed as a joint venture between Blue Cross and Blue Shield of Louisiana and Elevance Health, will end Dec. 31. More than 290,000 Medicaid members currently have Healthy Blue, according to a Sept. 1 news release from the department. While Medicaid eligibility does […] The post Louisiana’s Medicaid contract with Elevance-BCBS venture to end, affecting 290,000 appeared first on Becker's Payer Issues | Payer...
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CHI St. Vincent no longer part of Blue Cross Blue Shield of Arkansas network
CHI St. Vincent will not be part of the Blue Cross Blue Shield of Arkansas network after the Little Rock-based hospital system and the insurer failed to reach an agreement on renewing their contract, both sides announced Tuesday. The two failed to reach an agreement during negotiations over the past several months about how much […]
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UnitedHealthcare taps CEO for Washington state Medicaid plan
UnitedHealthcare Community Plan of Washington has named Scott Williams as CEO. According to an August LinkedIn post, Mr. Williams will work with members, providers, community groups, tribes and state leaders in his role with the Medicaid managed care plan. Prior to this position, Mr. Williams was a vice president of network contracting with UnitedHealth Group. […] The post UnitedHealthcare taps CEO for Washington state Medicaid plan appeared first on Becker's Payer Issues | Payer News .
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Florida sues 2 PBMs over alleged price fixing
Florida Attorney General James Uthmeier has filed a lawsuit against Prime Therapeutics and Cigna’s Express Scripts, alleging the pharmacy benefit managers entered into an illegal horizontal price-fixing agreement that threatens access to affordable medications. The lawsuit alleges the competitors entered a “collaboration” in December 2019 under which Prime, which is owned by BCBS plans, adopted […] The post Florida sues 2 PBMs over alleged price fixing appeared first on Becker's Payer Issues...
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‘Fundamentally different priorities’: Lee Health to go out of network for UnitedHealthcare members
Fort Myers, Fla.-based Lee Health said it would terminate hospital and physician contracts with UnitedHealthcare at the end of 2026. Beginning Jan. 1, 2027, Lee Health will be out of network for UnitedHealthcare employer-based, individual and Medicare Advantage plan members. Lee Health said UnitedHealthcare does not consider the health system to be part of the […] The post ‘Fundamentally different priorities’: Lee Health to go out of network for UnitedHealthcare members appeared first on Beck...
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Opinion: A billing code was supposed to incentivize relationship-based primary care for Medicare patients. It may not be working as hoped
Primary care is much more than what happens during an office visit, writes physician Ishani Ganguli.
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Arkansas BCBS, CommonSpirit’s CHI St. Vincent near contract deadline
Arkansas Blue Cross and Blue Shield and Little Rock, Ark.-based CHI St. Vincent, under Chicago-based CommonSpirit Health, are nearing their Sept. 1 contracting deadline without an agreement. On Sept. 1, CHI St. Vincent — including its four hospitals, 80 medical clinics and more than 300 providers — could leave all provider networks for Arkansas BCBS […] The post Arkansas BCBS, CommonSpirit’s CHI St. Vincent near contract deadline appeared first on Becker's Payer Issues | Payer News .
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Federal court rejects PhRMA challenge to Medicare drug price negotiation
A federal appeals court on Wednesday ruled against a lawsuit filed by representatives of the pharmaceutical industry challenging the federal Medicare drug price negotiation program, finding that drugmakers are not entitled to sell their products to Medicare at a price they would prefer. The U.S. Court of Appeals for the 5th Circuit affirmed a prior...
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Optum Rx taps employer, government markets president
Mona Chitre, PharmD, will serve as the market president for the newly created employer and government markets segment under Optum Rx, UnitedHealth Group’s pharmacy benefit manager. Dr. Chitre will begin her role Aug. 31, according to an Aug. 26 LinkedIn post. She said the role unifies the commercial, health system, coalition, labor and trust, and […] The post Optum Rx taps employer, government markets president appeared first on Becker's Payer Issues | Payer News .
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Cigna to manage NFL’s behavioral health network
Cigna Healthcare will manage a new behavioral health network for eligible current and former National Football League (NFL) players and their eligible dependents beginning Sept. 1. The NFL and NFL Players Association (NFLPA) created the Behavioral Health Network as an enhancement to the NFL Player Insurance Plan, according to an Aug. 26 news release from NFLPA. Cigna […] The post Cigna to manage NFL’s behavioral health network appeared first on Becker's Payer Issues | Payer News .
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Trump Administration Announces $3.15 Million to Expand Pharmacy Connectivity Throughout Rural Ohio Communities
Trump Administration Announces $3.15 Million to Expand Pharmacy Connectivity Throughout Rural Ohio Communities This federal investment will improve interoperability and management of patient healthcare coordination
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A look inside the expanded partnership between SCAN and Costco
SCAN Group and retailer Costco are expanding their partnership with the launch of new cobranded Medicare products.
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Blue Cross and Blue Shield of Illinois marks two years of progress through expanded special beginnings program
Blue Cross and Blue Shield of Illinois announced the second anniversary of its expanded Special Beginnings® Maternal and Infant Health Initiative, highlighting investments and partnerships supporting healthier outcomes for moms […]
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BCBS Tennessee pivots away from AI program that monitored employee work
BlueCross BlueShield of Tennessee has moved away from AI software that monitored employee work, according to an Aug. 19 report from the Chattanooga Times Free Press. The insurer confirmed to Becker’s that it recently ended a pilot based on employee feedback. The company had been using Skan AI, a platform that observes workflows and business […] The post BCBS Tennessee pivots away from AI program that monitored employee work appeared first on Becker's Payer Issues | Payer News .
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Only 13% of Medicare beneficiaries can accurately define coverage options: Survey
There’s widespread gaps in Medicare knowledge among both current beneficiaries and adults approaching eligibility for the program, even as most enrollees express high confidence in their understanding of the program, according to a new eHealth survey. The findings, released Aug. 20, were based on nationwide surveys of 1,000 adults conducted by a third-party vendor from […] The post Only 13% of Medicare beneficiaries can accurately define coverage options: Survey appeared first on Becker's Pay...
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Humana names chief medical officer
Humana tapped Shantanu Nundy, MD, to serve as the company’s chief medical officer, effective Aug. 31. According to an Aug. 20 news release, Dr. Nundy will inform the company’s AI use, products and platforms. He will report to Humana President and CEO Jim Rechtin, serving on the company’s enterprise leadership team. “I am confident Shantanu’s […] The post Humana names chief medical officer appeared first on Becker's Payer Issues | Payer News .
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Costco enters Medicare market through SCAN partnership
SCAN Health Plan and Costco will roll out insurance products for older adults in the coming years, according to an Aug. 18 news release. The Wall Street Journal reported that the companies would begin by selling jointly branded Medicare Advantage products in two states, as well as a Medicare supplement in a third state. While the geography was […] The post Costco enters Medicare market through SCAN partnership appeared first on Becker's Payer Issues | Payer News .
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Four health systems, including Ochsner and Denver Health, go live with Epic's real-time prior authorization checks
UnitedHealthcare, Network Health and Aetna are among the first group of health plans to go live with the API, while Ochsner Health, Froedtert ThedaCare Health, Denver Health and Summit Health are the four health systems now using the real-time prior auth checks.
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Providence Health Plan's Medicare Advantage sale falls through
After exploring options for the future, including a sale, Providence Health Plan announced this week that it will cease operations for most of its insurance businesses next year.
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In Idaho, an insurer says health care costs may rise after hospital taps Congress’s billing tool
Months after one of Idaho’s largest health insurers asked the state for help with unusual billing practices by a North Idaho hospital, the insurer is still waiting for assistance. Blue Cross argues that Post Falls ER & Hospital is out-of-network for health insurers and instead relies heavily on a new arbitration process created by Congress. […]
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Investors renew fight against UnitedHealth, claiming $237M in insider stock sales
UnitedHealth Group shareholders are renewing pressure on the company in an amended complaint, filed Aug. 7 in the U.S. District Court for the District of Minnesota. An initial complaint from July 2024 focused on concerns over the “firewall” between UnitedHealthcare and Optum. UnitedHealth established the policy in 2022 amid a Justice Department challenge of the […] The post Investors renew fight against UnitedHealth, claiming $237M in insider stock sales appeared first on Becker's Payer Issue...
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A look at where Aetna is seeing value-based care success in Medicare Advantage
Aetna is seeing its value-based care efforts pay off in both preventive care metrics and cost savings, according to a new analysis from the company.
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St. Luke’s, UnitedHealthcare automate 88% of claim statuses via Epic
Bethlehem, Pa.-based St. Luke’s University Health Network and UnitedHealthcare say they’ve automated claim status updates for 88% of the claims exchanged between the two organizations, using Epic’s Payer Platform, according to Epic’s newly released 2026-2027 Almanac. The two organizations turned on Epic’s Claim Status feature to give St. Luke’s staff real-time visibility into where claims […] The post St. Luke’s, UnitedHealthcare automate 88% of claim statuses via Epic appeared first on Becke...
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Humana, Cityblock partnership reaches 20,000 Medicare Advantage members in North Carolina
Cityblock Health, a tech-driven provider group, has partnered with Humana to serve nearly 20,000 Medicare Advantage and dual-eligible beneficiaries in North Carolina. According to an Aug. 13 news release, Cityblock has been supporting eligible Humana members with complex chronic conditions since July 1. Cityblock is working with members’ current primary care providers and the insurer’s […] The post Humana, Cityblock partnership reaches 20,000 Medicare Advantage members in North Carolina appea...
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Cityblock unveils partnership with Humana in North Carolina
Cityblock Health is expanding its footprint in North Carolina through a new partnership with Humana.
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56% of employers using Big 3 PBMs consider switch
Fifty-six percent of employer clients of “Big Three” pharmacy benefit managers — CVS Caremark, Cigna’s Express Scripts and UnitedHealth Group’s Optum Rx — are thinking about switching in the next one to three years. The 2026 “Pulse of the Purchaser” survey, released Aug. 11 by the National Alliance of Healthcare Purchaser Coalitions, included 408 responses […] The post 56% of employers using Big 3 PBMs consider switch appeared first on Becker's Payer Issues | Payer News .
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Elevance-backed physician group, Franciscan Alliance partner in value-based care push
Mishawaka, Ind.-based Franciscan Alliance has partnered with Millennium Physician Group to expand value-based care and primary care access across Indiana. Fort Myers, Fla.-based Millennium is part of a national value-based care platform partially owned by Elevance Health. The partnership will combine Franciscan’s physician network with Millennium’s practice management, analytics and value-based care capabilities. Franciscan physicians […] The post Elevance-backed physician group, Franciscan A...
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Alignment secures $200M credit line as it eyes plan acquisitions
Medicare Advantage insurer Alignment Health is expecting to grow into new markets and carry out acquisitions — and now has the financial backing to do so. The insurer laid out its plan in a July 30 Securities and Exchange Commission filing. Alignment anticipates acquiring healthcare delivery groups in targeted geographies, standalone and provider-sponsored MA plans, […] The post Alignment secures $200M credit line as it eyes plan acquisitions appeared first on Becker's Payer Issues | Payer Ne...
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UnitedHealth paid $3B for benefits platform Alegeus
UnitedHealth Group paid $3 billion for benefits administration platform Alegeus, according to an Aug. 10 filing with the Securities and Exchange Commission. The company had not previously disclosed a price for the deal. In the filing, which does not directly name Alegeus, UnitedHealth said it entered an agreement in the first quarter to acquire a […] The post UnitedHealth paid $3B for benefits platform Alegeus appeared first on Becker's Payer Issues | Payer News .
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Federal judge dismisses legal challenges to South Dakota drug discount law
A judge has ruled in favor of a South Dakota law that helps rural healthcare providers buy discounted drugs and mark up their sale price to fill budget holes created by low Medicare and Medicaid reimbursement rates. AbbVie, maker of the arthritis drug Humira, among other medications, sued the state in April 2025. The Chicago-based […]
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Blue Shield of California names health AI exec to board
Kedar Mate, MD, is joining Blue Shield of California’s board of directors, according to an Aug. 10 news release. Dr. Mate is currently chief medical officer of Qualified Health AI, an enterprise AI platform he founded for health systems. Previously, he was president and CEO of the Institute for Healthcare Improvement, a healthcare quality and […] The post Blue Shield of California names health AI exec to board appeared first on Becker's Payer Issues | Payer News .
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Missouri health system to stop offering ACA plans, partners with Oscar
Cox HealthPlans, the insurance arm of Springfield, Mo.-based CoxHealth, will stop selling ACA marketplace plans directly starting in 2027, instead partnering with insurer Oscar Health to offer marketplace coverage. The new Oscar plans will be built around CoxHealth’s network of hospitals and clinics in eight southwest Missouri counties. The health system said Aug. 7 it […] The post Missouri health system to stop offering ACA plans, partners with Oscar appeared first on Becker's Payer Issues |...
Oscar Health Missouri