Molina ‘beating the odds’ in Medicaid
Conservative planning and continued business growth helped Molina keep an ongoing mismatch between payment rates and member acuity from dinging its bottom line in the third quarter.
‘AI arms race’ underway as payers, providers jockey for upper hand in claims review
Payers currently have a leg up when using AI to review claims, but providers could soon catch up, experts say.
State Medicaid directors concerned about program’s stability: KFF
The presidential election, loss of higher federal funding, inflationary pressures and other challenges are leaving state regulators uncertain about Medicaid’s “new normal.”
Change Healthcare data breach officially affects 100M
The breach marks the largest ever reported to a portal managed by federal regulators.
Insurer lobby blames government policies for 2025 Medicare Advantage market makeup
The Better Medicare Alliance is warning of disruptions to care for America’s seniors, though MA premiums and major benefits are essentially unchanged next year.
PBM model is a ‘dead man walking.’ What comes next?
Executives from Amazon, Walgreens, Blue Shield of California and PhRMA weighed in on how to fix the much-scrutinized pharmacy benefit manager model during HLTH 2024.
Centene sues HHS over Medicare Advantage star ratings fall
Centene is emulating other insurers unhappy with how regulators handled quality ratings for 2025. The flurry of complaints is “symptomatic of what appear to be systemic issues” with CMS calculations, Centene said.
Thoughtful implementation, ongoing monitoring key to safe health AI
Healthcare organizations will need to test models in their local environments, keep an eye on performance and work together on implementing the technology, panelists said at HLTH.
Walmart adds pharmacy to same-day delivery
The retail giant said it’s responding to a top request from its customers. The option is now available in six states and will expand nationally.
Amazon’s One Medical, Cleveland Clinic partner to build primary care clinics in Ohio
The academic medical giant is the latest health system to notch a deal with One Medical, defraying the cost of expansion for the primary care chain while creating a valuable source of referrals for the hospital.