The Tukey outlier, guardrails on cut points and the end of Chevron are factors that may influence payer challenges to low 2025 MA star ratings, says Jenn Kerfoot, chief strategy and growth officer at DUOS.
Evernorth Health Services has selected Transcarent to power its new Oncology Benefit Services program. The digital platform included in the offering is geared to bring together cancer services across pharmacy and medical benefits and provide more personalized patient support via a dedicated care team.
The Cleveland Clinic and Amazon One Medical are collaborating on primary care clinics in Northeast Ohio. Amazon One Medical said it would open its first primary care office in affiliation with the Cleveland Clinic next year, offering same and next-day appointments, onsite lab services and virtual care support for members.
Humana has sued the Centers for Medicare and Medicaid Services over the results of the 2025 Medicare Advantage and Part D Star Ratings.
A new national survey shows more than 90% of independent pharmacists may not sell drugs for which the Medicare Part D program is trying to negotiate lower prices.
Elevance Health President and CEO Gail Boudreaux said the insurer is “considering all of our options” regarding the Centers for Medicare and Medicaid Services’ 2025 Medicare Advantage Star Ratings, which saw the company take a hit in its star ratings.
CVS Health President and CEO Karen Lynch is out at the company amid Friday’s release of preliminary financial guidance for the third quarter that fell short of Wall Street forecasts. Lynch stepped down from her position per agreement with the company’s board of directors, according to CVS Health.
Data is the lifeblood of AI, said Sundar Shenbagam, chief technology officer at Edifecs. The challenge is having a uniform way to collect the data and maintain it to make sure it remains secure. Once that’s established, data can be managed to come up with an AI model that automates some of the numerous time-consuming payer functions. […]
Despite challenges, healthcare executive pay increased 4.6% this year, on par with the 4.4% growth rate seen last year, though executives at the system level saw greater gains as compared to subsidiary hospital executives, according to SullivanCotter’s
Despite spending more on healthcare than any other nation, the U.S. is the lowest or second-lowest-ranking country when it comes to measures such as access, equity and outcomes, according to a new Commonwealth Fund analysis.