Competitive / Operational Strategy
Signals classified into this topic vertical.
61 signals
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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. […]
Blue Cross IdahoBlue Cross Blue Shield plans · 20 signals · last 30 days -
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...
UnitedHealthcare · 34 signals · last 30 days -
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.
AetnaCVS Health / Aetna · 10 signals · last 30 days -
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...
UnitedHealthcareUnitedHealthcare · 34 signals · last 30 days -
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...
Humana North CarolinaHumana · 13 signals · last 30 days -
Cityblock unveils partnership with Humana in North Carolina
Cityblock Health is expanding its footprint in North Carolina through a new partnership with Humana.
Humana North CarolinaHumana · 13 signals · last 30 days -
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 .
UnitedHealthOptumUnitedHealthcare · 34 signals · last 30 days -
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...
Elevance IndianaElevance Health · 11 signals · last 30 days -
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...
Competitive / Operational Strategy · 38 signals · last 30 days -
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 .
UnitedHealthUnitedHealthcare · 34 signals · last 30 days -
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 […]
Competitive / Operational Strategy · 38 signals · last 30 days -
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 .
Blue Shield CaliforniaBlue Cross Blue Shield plans · 20 signals · last 30 days -
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 MissouriOscar Health · 2 signals · last 30 days -
CVS Caremark taps chief growth officer
CVS Health’s pharmacy benefit manager, CVS Caremark, is bringing on Keith Reynolds as chief growth officer. Chief Sales Officer Jim Fowler will transition into retirement, according to an Aug. 7 LinkedIn post from Mr. Reynolds. Mr. Reynolds had spent 25 years at CVS Health and Aetna previously, the post said. He most recently was COO […] The post CVS Caremark taps chief growth officer appeared first on Becker's Payer Issues | Payer News .
CVS HealthAetnaCVS Health / Aetna · 10 signals · last 30 days -
STAT+: Pharmalittle: We’re reading about Replimune’s melanoma drug, a Medicare policy change, and more
Eli Lilly and Novo Nordisk convinced a federal judge to toss an antitrust lawsuit by a compound pharmacy
Competitive / Operational Strategy · 38 signals · last 30 days -
Sentara moves to end Anthem contracts in Virginia
Nearly 380,000 patients could go out of network with the health system if the commercial, Medicare and Medicaid contracts lapse.
Anthem VirginiaElevance Health · 11 signals · last 30 days -
Wisconsin insurer expands Cost Plus Drugs partnership
Network Health, the insurance arm of Wisconsin-based Froedtert ThedaCare Health, is expanding its partnership with Mark Cuban Cost Plus Drug Co. to include employer-sponsored health plan members. In early 2025, Network Health became one of the first insurers in the country to integrate Cost Plus Drugs into its Medicare Advantage pharmacy network. On Aug. 3, […] The post Wisconsin insurer expands Cost Plus Drugs partnership appeared first on Becker's Payer Issues | Payer News .
Competitive / Operational Strategy · 38 signals · last 30 days -
Oklahoma system out of network with Aetna
As of Aug. 1, non-emergency, scheduled elective services provided by Oklahoma-based Norman Regional Health System are no longer in network for Aetna members. The update affects commercial, Medicare Advantage and administrative-services-only plans, with Medicaid excluded. Norman Regional said negotiations had been ongoing “for months.” “Across the country, healthcare providers are experiencing rising costs related to […] The post Oklahoma system out of network with Aetna appeared first on Beck...
Aetna OklahomaCVS Health / Aetna · 10 signals · last 30 days -
Trump slashes Medicare drug subsidies, cutting against affordability message
The end of a subsidy program that helped keep costs down for Medicare drug coverage could leave millions of seniors with higher monthly costs, a move that undermines the Trump administration's message of cutting drug costs. President Trump often touts his push for access to cheaper drugs through the TrumpRx platform and making “most-favored-nation” deals...
Competitive / Operational Strategy · 38 signals · last 30 days -
Why specialists see risk in Medicare’s doctor pay overhaul plan
“Primary care is very important. They need more money. Everybody needs more money,” said Dr. Murad Alam, a dermatologist.
Competitive / Operational Strategy · 38 signals · last 30 days -
Elevance names chief commercial officer for Carelon
Brad Kirkpatrick will serve as chief commercial officer for Elevance Health’s services business, Carelon, effective Aug. 10. In a July 29 LinkedIn post, Mr. Kirkpatrick said he will bolster the commercial strategy, enrich partnerships and build a more connected experience for clients and health plans. “We’ll focus on delivering innovative solutions, driving sustainable growth and […] The post Elevance names chief commercial officer for Carelon appeared first on Becker's Payer Issues | Payer N...
ElevanceElevance Health · 11 signals · last 30 days -
UnitedHealthcare, U of Miami Health face network split
University of Miami Health System is set to go out of network with UnitedHealthcare Aug. 1 if the two sides do not reach a new contract. Without an agreement, UHealth’s hospitals, facilities and physicians will be out of network for UnitedHealthcare’s employer-sponsored plans, its Florida Medicaid plan and its ACA plans. A separate contract covers […] The post UnitedHealthcare, U of Miami Health face network split appeared first on Becker's Payer Issues | Payer News .
UnitedHealthcare FloridaUnitedHealthcare · 34 signals · last 30 days -
Judge denies Cigna bid to have health data-tracking lawsuit tossed
A Pennsylvania federal judge ruled that four of the five claims in a lawsuit alleging Cigna violated privacy protections through third-party vendors using tracking technologies on its website can proceed. The complaint dates to May 2025, with the most recent amended complaint from March 2026. Plaintiffs include current and past Cigna policyholders who allege a […] The post Judge denies Cigna bid to have health data-tracking lawsuit tossed appeared first on Becker's Payer Issues | Payer News .
Cigna PennsylvaniaCigna · 10 signals · last 30 days -
MultiCare, Premera reach deal to keep coverage for over 100K WA patients
MultiCare, which operates more than a dozen hospitals in Washington, has agreed to keep charging Premera Blue Cross insurance customers in-network rates after months of negotiations that threatened their coverage. The hospital system and insurer are still hashing out the details, Bill Akers, executive vice president of sales and marketing for Premera, said Tuesday. Both […]
Blue Cross WashingtonBlue Cross Blue Shield plans · 20 signals · last 30 days -
Dogwood notifies attorney general’s office that HCA is in ‘potential noncompliance’ with Mission sale contract
By Ted Clifford Asheville Watchdog A report from the independent monitor tasked with supervising Mission Hospital has found two areas of “potential noncompliance” with the agreement HCA Healthcare signed when buying the hospital in 2019. The potential violations were a warning from federal regulators in October 2025 that Mission stood to lose Medicaid and Medicare […] The post Dogwood notifies attorney general’s office that HCA is in ‘potential noncompliance’ with Mission sale contract appear...
Competitive / Operational Strategy · 38 signals · last 30 days