Hospitals have been acquiring ambulatory care centers at a decent clip in many markets, and this could have a detrimental effect on consumers’ premiums and out-of-pocket spending due to the resulting outpatient facility fees, according to a new report from Georgetown University.
Greg Miller, chief growth officer at Lumeon, said the care environment is ripe for change and that automation can help with short staffing and alleviate costs.
Cigna is being sued for using algorithms to allegedly deny claims. The lawsuit, filed Monday in federal court in California, claims Cigna developed an algorithm known as PXDX to enable its doctors to automatically deny payments in batches of hundreds or thousands at a time for treatments that do not match certain preset criteria. This […]
Claiming that its old policy statements no longer reflect current market dynamics, the Federal Trade Commission has voted to rescind its prior statements of advocacy for pharmacy benefit managers, effectively ending the agency’s previously stated endorsement of PBMs. According to the FTC, the new statement pulling its advocacy is a response to PBMs’ continued reliance […]
The Office of Inspector General has released a report examining prior authorization patterns from seven managed care companies, and based on the findings is urging increased oversight of prior authorization denials in Medicaid Advantage.
Payel Das, principal research staff member and manager in the Trusted AI department of IBM, and an IBM master inventor, said LLMs can help to fill gaps in distribution and generate insights based on the missing data.
AHIP has named Dr. LaShawn McIver as its new chief health equity officer, effective immediately. The insurer group is framing the hire as part of its efforts to advance health equity. McIver will lead AHIP’s health equity initiatives, setting and driving strategies to improve health equity for underrepresented and medically underserved communities. She reports to […]
The U.S. Department of Justice and the Federal Trade Commission have released draft guidelines that tighten the review of mergers and acquisitions.
The Department of Health and Human Services, through its Substance Abuse and Mental Health Services Administration, is announcing awards in five grant programs devoted to combating multiple facets of substance misuse and the nation’s overdose epidemic. The grant awards total up to $47.8 million.
Due to the financial instability of Friday Health Plans of Colorado and growing concerns about healthcare providers refusing to treat Friday enrollees, the Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), is asking the courts to move Friday Health into liquidation. Colorado marks the latest state to put Friday Health […]