Competitive / Operational Strategy
Signals classified into this topic vertical.
115 signals
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Blue Shield of California must face mental health ‘ghost network’ claims
A federal judge allowed portions of a putative class action lawsuit against Blue Shield of California and Magellan, the insurer’s contracted mental health services administrator, to move forward over allegations that they published an inaccurate directory of mental health providers, according to a Sept. 23 court order. The plaintiffs are Blue Shield subscribers who alleged […] The post Blue Shield of California must face mental health ‘ghost network’ claims appeared first on Becker's Payer Is...
Blue Shield CaliforniaBlue Cross Blue Shield plans · 36 signals · last 30 days -
Trump Administration Announces $20 Million to Expand Telehealth Access and Upgrade Healthcare Technology Across Rural North Carolina
Trump Administration Announces $20 Million to Expand Telehealth Access and Upgrade Healthcare Technology Across Rural North Carolina This federal investment will help expand virtual care, upgrade electronic health records, strengthen cybersecurity, and equip rural providers with new technology to better serve patients
Competitive / Operational Strategy · 36 signals · last 30 days -
Cigna unveils $3B productivity initiative, including use of AI
The company will focus on automating and modernizing processes, better managing suppliers, partners and vendors and making employees more efficient, executives said during a Wednesday investor day.
CignaCigna · 15 signals · last 30 days -
Better Medicare Alliance Unveils 10-Point Policy Roadmap to Protect Medicare Advantage Affordability, Choice and Stability
Agenda calls for faster prior authorization decisions, stronger oversight of in-home health risk assessments, a next-generation risk model and greater stability for more than 35 million beneficiaries WASHINGTON — Better … Continue reading "Better Medicare Alliance Unveils 10-Point Policy Roadmap to Protect Medicare Advantage Affordability, Choice and Stability" The post Better Medicare Alliance Unveils 10-Point Policy Roadmap to Protect Medicare Advantage Affordability, Choice and Stability a...
Competitive / Operational Strategy · 36 signals · last 30 days -
HCA-affiliated St. David’s hospitals to go out of network with Cigna
Austin, Texas-based St. David’s HealthCare, a partnership between Nashville, Tenn.-based HCA Healthcare and two nonprofits, is set to go out of network with Cigna Oct. 1. St. David’s hospitals, ASCs and affiliated hospital-based physicians in Texas will no longer be available in network, the health system’s website said. “St. [David’s] HealthCare’s owner HCA is demanding […] The post HCA-affiliated St. David’s hospitals to go out of network with Cigna appeared first on Becker's Payer Issues |...
Cigna TexasCigna · 15 signals · last 30 days -
SCAN expands reach into Oregon in partnership with the Springs Living
SCAN Health Plan is teaming up with the Springs Living, a senior living organization, to launch new co-branded products that aim to offer a more connected experience for people living in these communities.
SCAN OregonSCAN Health Plan · 12 signals · last 30 days -
SCAN expands into Oregon by partnering with assisted-living organization
SCAN Health Plan is expanding into Oregon through a partnership with The Springs Living, an independent-living, assisted-living and memory care provider for older adults. The expansion brings the Medicare Advantage insurer into Oregon’s Clackamas and Washington counties. SCAN and The Springs Living will also launch co-branded products available Jan. 1. “The future of healthcare for […] The post SCAN expands into Oregon by partnering with assisted-living organization appeared first on Becker's...
SCAN Health Plan · 12 signals · last 30 days -
UnitedHealth’s home health arm hit by phone phishing breach
LHC Group, a home health and hospice provider owned by UnitedHealth Group’s Optum, has disclosed a data breach tied to a vishing attack that exposed patient information. LHC Group said it became aware April 7 that an employee may have fallen victim to a voice phishing scheme, according to the September notice. The company’s third-party […] The post UnitedHealth’s home health arm hit by phone phishing breach appeared first on Becker's Payer Issues | Payer News .
UnitedHealthOptumUnitedHealthcare · 46 signals · last 30 days -
Cigna, Baptist forge multiyear agreement following June cutoff
Jacksonville, Fla.-based Baptist Health and Cigna Healthcare announced a multiyear agreement Sept. 23 after the health system went out of network in June. Effective immediately, the agreement restores in-network access to providers, clinics and hospitals. A Baptist news release said the agreement includes Wolfson Children’s Hospital. “Throughout these discussions, both Baptist Health and Cigna Healthcare […] The post Cigna, Baptist forge multiyear agreement following June cutoff appeared firs...
CignaCigna · 15 signals · last 30 days -
Cigna partners with OpenAI, starting with oncology
The Cigna Group is partnering with OpenAI to integrate AI into clinical workflows, with a first focus on cancer care. Under the collaboration announced Sept. 23, OpenAI’s tools will be built into workflows across Accredo Specialty Pharmacy and the insurance business, Cigna Healthcare. The first new capability will give oncology nurses and case managers an […] The post Cigna partners with OpenAI, starting with oncology appeared first on Becker's Payer Issues | Payer News .
CignaCigna · 15 signals · last 30 days -
UnitedHealthcare, Cigna, Centene join national shared provider credentialing program
UnitedHealthcare, Cigna and Centene are among the initial participants in a national shared provider credentialing program, launching in the fall. CertifyOS, a provider data intelligence company, announced the program Sept. 23. The initiative aims to standardize credentialing and verification, speed up the time to join an insurance network and serve as a reliable source of […] The post UnitedHealthcare, Cigna, Centene join national shared provider credentialing program appeared first on Becke...
UnitedHealthcareCignaUnitedHealthcare + Cigna · 59 signals · last 30 days -
WakeMed reaches deal for UnitedHealthcare commercial members after nearly 1 year of negotiations
Raleigh, N.C.-based WakeMed has reached a three-year contract for UnitedHealthcare’s employer-sponsored commercial plans, effective Oct. 15. WakeMed shared the update Sept. 17. The contract will grant members in-network access to hospitals, outpatient clinics and specialty physicians. An archived page from WakeMed’s website showed it had gone out of network for these members, along with UnitedHealthcare’s […] The post WakeMed reaches deal for UnitedHealthcare commercial members after nearly 1...
UnitedHealthcareUnitedHealthcare · 46 signals · last 30 days -
Chief medical officer for CVS’ Oak Street Health steps down
Marisa Rogers, MD, has left her role as chief medical officer for Oak Street Health, CVS Health’s primary care company for older adults. “We built our clinical teams, invested in our leaders, advanced our care model, improved quality, and navigated more change and transformation than I could have imagined,” Dr. Rogers said in a Sept. […] The post Chief medical officer for CVS’ Oak Street Health steps down appeared first on Becker's Payer Issues | Payer News .
CVS HealthCVS Health / Aetna · 12 signals · last 30 days -
Elevance hit with another lawsuit over out-of-network penalty policy
Elevance Health’s out-of-network penalty policy has been met with significant resistance — and another lawsuit filed Sept. 17 is adding fuel to the fire. The Neurological Surgery Practice of Long Island filed the complaint in a New York federal court, targeting a policy that expanded to the state in July. Under the policy, network hospitals […] The post Elevance hit with another lawsuit over out-of-network penalty policy appeared first on Becker's Payer Issues | Payer News .
Elevance New YorkElevance Health · 16 signals · last 30 days -
Ascension to sell its stake in Arizona insurer to Aetna
St. Louis-based Ascension has reached an agreement to transfer full ownership of its co-owned Arizona managed care health plan, Mercy Care, to CVS Health subsidiary Aetna, a spokesperson for Ascension confirmed with Becker’s. Ascension co-owns the plan with San Francisco-based CommonSpirit’s Dignity Health. The agreement is subject to regulatory reviews and approvals. “Mercy Care has long served vulnerable […] The post Ascension to sell its stake in Arizona insurer to Aetna appeared first on...
CVS Health / Aetna · 12 signals · last 30 days -
Trump Administration Announces $167 Million to Build Rural Care Sites, Upgrade Health Technology, and Strengthen Prevention Across South Carolina
Trump Administration Announces $167 Million to Build Rural Care Sites, Upgrade Health Technology, and Strengthen Prevention Across South Carolina This federal investment will support telehealth, remote monitoring, mobile care, cybersecurity upgrades, and new technology to improve maternal and behavioral healthcare
Competitive / Operational Strategy · 36 signals · last 30 days -
Trump Administration Announces $50 Million to Optimize Care Delivery and Improve Rural Hospital Infrastructure in Connecticut
Trump Administration Announces $50 Million to Optimize Care Delivery and Improve Rural Hospital Infrastructure in Connecticut This federal investment will help rural hospitals upgrade equipment, renovate facilities, enhance care delivery, and support long-term sustainability across rural Connecticut
Competitive / Operational Strategy · 36 signals · last 30 days -
UnitedHealthcare’s ASC deals didn’t hurt patients: Study
UnitedHealthcare’s acquisition of nearly 300 ASCs over the last decade wasn’t associated with reduced procedure volume, fewer physicians, changes to patient mix or worse quality of care, according to a study published in the September issue of Health Affairs. The finding lands as regulators have grown increasingly vocal about the risks of insurer-provider vertical integration. […] The post UnitedHealthcare’s ASC deals didn’t hurt patients: Study appeared first on Becker's Payer Issues | Payer...
UnitedHealthcareUnitedHealthcare · 46 signals · last 30 days -
SCAN Health Plan, Walmart partner on Medicare Advantage plans
The collaboration could offer customers pharmacy and vision services, food and over-the-counter benefits, pending regulatory review and approvals
SCANSCAN Health Plan · 12 signals · last 30 days -
Centralized platform for managing independent dispute resolutions opens
A new centralized platform by the Centers for Medicare & Medicaid Services for managing federal independent dispute resolutions related to the No Surprises Act opened Sept. 15. The Independent Dispute Resolution Gateway allows users to start and respond to disputes; access dispute dashboards and reports associated with their organization; track dispute information, including those assigned to a certified IDR entity; monitor assigned disputes by process phase; and review notifications regardin...
Competitive / Operational Strategy · 36 signals · last 30 days -
Trump Administration Expands Preventive and Behavioral Healthcare Access for Students Across Rural North Carolina
Trump Administration Expands Preventive and Behavioral Healthcare Access for Students Across Rural North Carolina This federal investment will strengthen school-based healthcare through new locations, telehealth and mobile care for children in rural communities
Competitive / Operational Strategy · 36 signals · last 30 days -
AHA, Kaufman Hall issue report on mergers and acquisitions
A new report from Kaufman Hall prepared for the AHA highlights new insights and data on hospital mergers and acquisitions. An AHA blog accompanying the report is also available.The report discusses how hospital merger reviews should look beyond the potential impact on commercial insurance prices and consider what proposed transactions mean for all patients, particularly the nearly 60% of hospital patient days attributable to Medicare, Medicaid and Medicare Advantage beneficiaries whose paymen...
Competitive / Operational Strategy · 36 signals · last 30 days -
Elevance sues former network exec to block Oscar move
Elevance Health is suing a former vice president and asking a federal court to stop him from starting a new job at Oscar Health, alleging the move would put the insurer’s trade secrets in the hands of a direct competitor. The suit is at least the fifth Elevance has brought against departing executives over noncompete […] The post Elevance sues former network exec to block Oscar move appeared first on Becker's Payer Issues | Payer News .
ElevanceOscar HealthElevance Health + Oscar Health · 18 signals · last 30 days -
Insurer-owned specialty pharmacies tied to better drug access in Medicare Advantage: Humana study
Medicare Advantage enrollees who filled specialty medications through a pharmacy owned by their insurer got their drugs faster and paid less out of pocket than those who used nonintegrated pharmacies, according to a July study published in Health Affairs Scholar. The peer-reviewed study was conducted by researchers at Humana Healthcare Research and Brown University School […] The post Insurer-owned specialty pharmacies tied to better drug access in Medicare Advantage: Humana study appeared fi...
HumanaHumana · 13 signals · last 30 days -
Optum Insight names Amazon alum as chief AI officer
Ujjwal Ratan has joined UnitedHealth Group’s consulting and analytics division, Optum Insight, as chief AI officer. In a Sept. 10 LinkedIn post, Mr. Ratan said his role is to enable Optum Insight to operate as a connected agentic network in healthcare. “Agentic AI only works if the agents have real, connected data to reason over […] The post Optum Insight names Amazon alum as chief AI officer appeared first on Becker's Payer Issues | Payer News .
UnitedHealthOptumUnitedHealthcare · 46 signals · last 30 days