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U.S. health plans today operate in a world of rising expectations. They must work to contain rising healthcare costs, while at the same time catering more to consumers as the ultimate users of their products, rather than solely satisfying the demands of employers.

In our last column, we took a look at how U.S. health plans operate in a world of rising expectations based on: value-based reimbursement; consumerization; healthcare cost management; and regulatory compliance. In this second part of the series, we’ll give the best strategic plan of attack for each of these four trends.

In the first part of this series, we looked at a transformative year in healthcare and presented the ongoing shift from the Risk Adjustment Processing System to the Encounter Data Processing System. Here we present submission deadlines and what success does, and doesn’t mean, so plans are not surprised when a high acceptance rate results […]

Earlier this year, the Centers for Medicare and Medicaid Services released the results of the first year of the reinsurance and risk adjustment provisions of the Patient Protection & Affordable Care Act.

Finding the path to success in the post-Affordable Care Act world of healthcare represents a great opportunity and challenge for payer organizations. Part of that journey is changing the relationship dynamic between payers and providers.

A group of 72 healthcare organizations, including the American Telemedicine Association and the American Psychiatric Association, has penned a letter to the Drug Enforcement Administration and Department of Health and Human Services asking the agencies to permanently waive the requirement that patients receive an in-person evaluation prior to being pre

A little over a month ago, Scripps Health made a plea to patients in San Diego: Be kind to healthcare workers. They’re exhausted, they’re burned out, and they increasingly have to deal with demeaning and verbally abusive comments from patients.

Dr. Patrick J. Guffey, chief medical information officer at Children’s Hospital Colorado, is on a mission to get rid of pagers. Most are not HIPAA compliant. There’s no link from pager to the EHR without manual transcription. It’s another device physicians have to carry in addition to their smartphones, Guffey said.  But most physicians carry […]

After a $150 million Series D funding round announced in December, Papa CEO and founder Andrew Parker has plans for the senior-care startup.  

As a concept, Medicare Advantage isn’t new. Originally known as Medicare Plus Choice, it was passed with bipartisan support under the Clinton Administration with an eye toward giving seniors another option for receiving Medicare benefits. Flash forward to 2022, and the program has evolved into a full-blown force: Payers love it, patients report high satisfaction […]

In his State of the Union address, President Joe Biden called for Medicare to set higher standards for nursing homes. The most controversial is the president’s call for “sufficient” staffing.

The Department of Health and Human Services, through the Substance Abuse and Mental Health Services Administration and the Office of Minority Health, will provide close to $35 million in funding toward strengthening and expanding mental health services and suicide prevention programs for children and young adults. Of the total, $9.2 million comes from the American […]

As President Biden promised in his State of the Union address, the Department of Justice has appointed a prosecutor for pandemic fraud. The DOJ on Thursday named Associate Deputy Attorney General Kevin Chambers as director for COVID-19 Fraud Enforcement. 

Anthem plans to rebrand with a new name, Elevance Health, provided the change is approved by shareholders, the insurer said this week. The new name is meant to underscore the company’s focus on “elevating” whole health, according to the announcement.

ORLANDO – Healthcare Information Technology now enables Personal Health Information, or PHI, to be accessed immediately and directly by patients, but there are complex regulatory requirements around the sharing of patient data that affect all parties – physicians, payers and the patients themselves. 

ORLANDO – The secret to living a healthier life is farily simple: eat more fruits and vegetables and less of what you shouldn’t eat, according to Whole Foods cofounder and CEO John Mackey, who spoke as the Executive Summit opening keynote at HIMSS22 in Orlando. Cris Ross, CIO Mayo Clinic, and chairman of the Board of the […]

More than ever before, data drives the business of healthcare. The COVID-19 pandemic in particular brought statistics, data and analytics to the forefront, and the healthcare industry saw real scrutiny on the source of its data, as well as the collection methods and analysis around it.

ORLANDO – Personalizing what nurses want for quality of life and career goals, using digital tools to free up their time and giving awareness to their hard work are solutions  two health systems are using to stem the Great Resignation.

A jury has found Sutter Health not guilty of using its market power to force health insurance companies into using its hospitals and physicians. Insurers were forced into higher-cost contracts even when less expensive options were available, according to the class action lawsuit filed in 2012. In Djeneba Sidibe v. Sutter Health, the jury found […]

ORLANDO – Value-based care will continue to accelerate, and the best way forward for health systems, from both a financial and clinical quality standpoint, is to have a clear transition plan and a robust population health framework.

ORLANDO – It’s been less than a year since the Department of Health and Human Services implemented a new measure to the Protect Patient Health Information objective requiring eligible hospitals and critical access hospitals to complete an annual assessment of SAFER (Safety Assurance Factor

ORLANDO, Fla. – Government health officials tied the importance of interoperability to health equity Tuesday during the HIMSS22 session “View From the Top: HIMSS Foundation Working Towards Health Equity.”

ORLANDO – 60 Minutes correspondent Scott Pelley asked a panel of healthcare workforce professionals during HIMSS22 on Tuesday about what needs to be done to turn around resignations and burnout. Eight percent of healthcare jobs are vacant, Pelley said, his strong and familiar baritone instantly recognizable. Sixty-six percent of nurses have said they felt like quitting.

ORLANDO, Fla. – Even before COVID-19 made the business of healthcare a nightmare for countless physicians and clinicians, burnout was a prevalent issue. And even the slow, still-ongoing emergence into normalcy hasn’t been enough to ease this trend: Clerical burdens, including clinical documentation, are a major contributor.

ORLANDO – More than 1.5 million Medicare beneficiaries were enrolled in hospice care for at least one day during 2018, a 17% jump in about four years. While hospice care is useful and compassionate, especially when focusing on quality of life for terminally ill patients, there’s a problem that looms: At least 14% of Medicare […]

ORLANDO, Fla. – A panel of provider, payer and tech experts speaking at HIMSS22 went beyond the issue of health equity to address ways their organizations are tracking and helping to solve gaps.

ORLANDO, Fla. – Healthcare has undergone a number of policy and technology shifts in recent years, and at the intersection of these changes is Fast Healthcare Interoperability Resources, or FHIR. It’s a standard that describes data formats and an API for exchanging electronic health records, and while many in the data business consider it the […]

To get staff on board with digital transformation, everyone who will be using the system must be included in decision-making, according to Dr. John Chessare, president and CEO of the Greater Baltimore Medical Center Healthcare System. How it usually works, he said during HIMSS22, is that “you get a group of people to decide something […]

Multiple gold medal winner Michael Phelps walked onto the stage at HIMSS22 to a strong round of applause from a full house in the Valencia Ballroom in the Orange County Convention Center in Orlando. Phelps, the closing keynote on Friday, brought a message that has been top of mind in healthcare during COVID-19: the need […]

ORLANDO – Healthcare organizations from payers to providers have been sounding a common refrain in recent years: Provide the right care at the right place at the right time. Various hospital-at-home programs have popped up in response to this ethos, and some of the most successful entail payer-provider partnerships.

RevSpring and Cerner are expanding their partnership through omnichannel payment solutions to boost performance and patient engagement. More than 1,500 Cerner customers can access RevSpring’s PersonaPay, Talksoft and IVR Advantage solutions, to streamline, for example, the coordination of all payment data and communications in back-office work.

In recognition of the difficulties faced by healthcare workers, President Biden has signed into law the “Dr. Lorna Breen Health Care Provider Protection Act,” which authorizes programs to improve mental and behavioral health among healthcare providers.

In the spring of 2020, the virus that causes COVID-19 was tearing across the country and wreaking havoc on patients and on the healthcare systems that served them. No hospital, system or ancillary facility was left unaffected. In South Dakota, when the regional health system Avera Health saw clinics shut down and its hospitals in […]

During HIMSS22, Philips gave its top predictions for the future of healthcare systems over the next three years based on labor market trends and the expansion of hospital-at-home services. Roy Jakobs, chief business leader of Connected Care at Philips, offered the following predictions:

The Department of Health and Human Services is establishing a number of grant programs, encompassing $43.7 million worth of funding, that are intended to strengthen mental health and substance use services for those with HIV and AIDS.

Telehealth technology has been cited for its convenience, especially when usage skyrocketed during the COVID-19 pandemic, but there are also frustrations, according to recently released UnitedHealth Group research.

Telehealth was a critical lifeline for people in the early days of the COVID-19 pandemic, though this was especially true for Medicare beneficiaries, with more than 28 million beneficiaries using virtual health services during the first year of the public-health emergency, according to a report from the Department of Health and Human Services’ Office of […]

The use of algorithms has saved lives at the University of Missouri Health Care. The health system put in place an early-warning system tied to the EHR to alert rapid-response teams of a patient’s risk for developing sepsis, a life-threatening infection.

The Department of Health and Human Services, through the Health Resources and Services Administration, has announced more than $413 million in Provider Relief Fund payments is going to more than 3,600 providers across the country. 

Moderna said it’s planning to submit a request to the U.S. Food and Drug Administration to authorize a low-dose COVID-19 vaccine for children under 6 years old, part of a push to inoculate the 18 million American children under 5 who are not yet eligible for vaccination – the last group to await eligibility.

Slightly more than 40% of family physicians were named in a malpractice lawsuit in 2021, and while that number is significant, it’s an eight percentage-point decrease from two years prior, according to new data published by Medscape.

Jeff Francis, CFO and vice president of Finance for Methodist Health System in Omaha, Nebraska, worked with Amy Raymond, head of Revenue Cycle Operations at AKASA, for unified automation of the health system’s revenue cycle that tied into its Cerner EHR.

The Confidentiality Coalition and the Workgroup for Electronic Data Interchange has sent a letter to the secretaries of Commerce and Health and Human Services voicing concerns about the potential misuse of patient health information by unregulated third-party applications.

During the first 12 months of President Joe Biden’s administration, close to 6 million new consumers signed up for coverage through the federal marketplace during the open and special enrollment periods, according to new data published by the Centers for Medicare and Medicaid Services. That includes about 3 million people who signed up during the […]

The American Hospital Association has expressed concerns about violence against healthcare workers, telling U.S. Attorney General Merrick Garland in a letter this week that the COVID-19 pandemic has exacerbated the issue.

A federal appeals court has upheld the Federal Trade Commission’s preliminary injunction against Hackensack Meridian Health  from acquiring the Englewood Healthcare Foundation.

The U.S. Court of Appeals for the 9th Circuit recently sided with United Behavioral Health in a decision reversing a lower court ruling ordering the UnitedHealth Group subsidiary to reprocess thousands of claims for mental health coverage. In 2019, plaintiffs in the class action lawsuit successfully won their case in district court that UBH breached […]

President Joe Biden’s proposed 2023 budget submitted to Congress gives the Department of Health and Human Services $127.3 billion in discretionary budget authority and $1.7 trillion in mandatory funding.  

There are several legislative proposals in Congress, some stalled and some nascent, that would propose a $35 per-month cap on what insured Americans would pay out-of-pocket for insulin – and this cap in costs would benefit about 25% of those on individual and small group markets, and about 20% of those in larger employer-sponsored plans.

The Food and Drug Administration today authorized both Pfizer and Moderna to give a second booster dose of their COVID-19 vaccines to individuals 50 years of age and older and to those who are immunocompromised. The additional shot follows completion of a three-dose primary vaccination series at least four months after the first booster.

UnitedHealth Group subsidiary Optum will combine with in-home healthcare service provider LHC Group, with UHG purchasing the latter for about $5.4 billion. LHC provides healthcare services in the home for a demographic of mostly older patients dealing with chronic illnesses and injuries. It will be melded with Optum, which manages drug benefits and offers data […]

“Break into the Boardroom,” a program designed to promote greater representation of female healthcare executives in corporate boardrooms, has identified and trained more than 220 women healthcare leaders and helped place 56 of its alumni and program affiliates onto corporate boards across the healthcare sector, according to its creators. Deerfield Management and Oxeon Holdings joined […]

The American Hospital Association has launched what it calls the Health Equity Roadmap, a framework meant to provide customized resources and action plans for health systems looking to become more equitable and eliminate structural barriers to health.

The Centers for Medicare and Medicaid Services has issued a proposed rule updating hospice-based payments and the aggregate cap amount for fiscal year 2023.

The American Hospital Association is prompting the Federal Trade Commission and the U.S. Department of Justice to update its merger guidelines, in response to a request by the two federal agencies for comments and suggestions on how to overhaul the merger rules. The FTC and DOJ have solicited suggestions on how to modernize the guidelines […]

Operating margins at hospitals and health systems have been hit hard by the pandemic, and the Omicron surge was an additional setback as the healthcare industry continued to struggle at the beginning of the year.

Geisinger, an integrated health system of over 3 million patients in the central, northeastern section of  Pennsylvania, had a problem faced by hospitals and patients nationwide: Type 2 diabetes.

Inpatient psychiatric facility payments are expected to increase by 1.5%, or $50 million next year under Medicare’s Inpatient Psychiatric Facility Prospective Payment System proposed rule for fiscal year 2023. 

CVS Health has entered into an agreement with the State of Florida to pay the state $484 million to resolve claims dating back more than a decade related to prescriptions for opioid medications that were filled at Florida CVS Pharmacy locations.

More than 90% of patients in a new survey say they’re satisfied with the service provided by local healthcare providers, but they’re frustrated with certain aspects of their care, including wait times and price transparency.

Providers are bracing for the end of government funds to administer COVID-19 vaccines.

Beginning late last week, the Biden Administration extended postpartum healthcare coverage to as many as 720,000 pregnant and postpartum people across the U.S., who are now assured Medicaid and Children’s Health Insurance Program (CHIP) coverage for a full 12 months after pregnancy.

UCare, a nonprofit health plan serving Minnesota and western Wisconsin, has tapped healthcare guidance and transparency technology company HealthSparq on a price transparency solution months before the Centers for Medicare and Medicaid Services rule goes into effect for payers.. The partnership is to give members more personalized and accurate cost estimates for healthcare services for […]

Medicare Advantage plan payments are expected to get an 8.5% revenue increase for 2023. This is an increase over the 7.98% proposed in the February advance notice.

Despite the increased demand for patient care in 2021, the growth in national healthcare spending is estimated to have slowed to 4.2%, from 9.7% in 2020, according to the 2021-2030 National Health Expenditure report released by the Centers for Medicare and Medicaid Services. 

The U.S. Government Accountability Office is asking the Centers for Medicare and Medicaid Services to gauge the effect that an increase in telehealth utilization is having on the care quality experienced by Medicaid beneficiaries. The GAO cited statistics showing usage continues to rise.

The Centers for Medicare and Medicaid Services yesterday released 2023 Medicare Advantage capitation rates and Parts C and D payment policies, and it has drawn reaction from insurer group AHIP, which praised the administration for promoting innovation and flexibility but expressed concerns over potentially “unworkable” policies.

The Treasury Department is releasing a proposed rule to fix a problem in the Affordable Care Act called the “family glitch,” President Joe Biden said Tuesday, in a press briefing that included former President Barack Obama and Vice President Kamala Harris.

Intermountain Healthcare, headquartered in Salt Lake City, and Colorado-based SCL Health, have finalized their merger after getting official approval from the Colorado attorney general’s office. The AG’s office issued an opinion allowing the merger to proceed.

Blue Shield of California and Walgreens Health are expanding access to in-person and virtual care options through the launch of 12 new Walgreens Health Corner locations in the San Francisco Bay Area and Los Angeles County.

Optum and Change Healthcare are extending their merger agreement to the end of the year, ahead of their scheduled trial starting August 1. The new merger deadline is December 31. As part of the extension, Optum will pay a $650 million fee to Change Healthcare in the event the merger is unable to be completed […]

AllianceRx Walgreens Prime, a specialty home delivery pharmacy owned by Walgreens, will be rebranding this summer as AllianceRx Walgreens Pharmacy, reflecting Walgreens’ full ownership of the service, which was announced in January. AllianceRx Walgreens Pharmacy CEO Joel Wright said via statement that while the name is changing, the service itself should remain largely the same.

Eliquis and Xarelto, two blood-thinning medications that are already among Medicare’s costliest, have seen their list prices more than double since entering the market, finds a new report by Patients for Affordable Drugs.

The Centers for Medicare and Medicaid Services is proposing to delay the start date of the Radiation Oncology Model, to a date that will be determined through future rulemaking. 

The U.S. government, as well as pharmaceutical companies that manufacture COVID-19 vaccines, have promoted booster shots as a way to ramp up protection when inoculation from the initial round of vaccines begins to decrease. A new study has found that protection from a second booster dose of Pfizer’s offering begins to wane after about four […]

Healthcare mergers and acquisitions data shows only 12 transactions recorded during the first quarter of the year, continuing a downward trend: To date, it’s the lowest number of consolidations since Kaufman Hall first started tracking these statistics in 2016.

The current public health emergency ends on April 16, with the federal government giving all indication of the coming end of the PHE, according to Michael P. Strazzella, head of Federal Government Relations at Buchanan Ingersoll and Rooney.

It’s been a long pandemic for the U.S. healthcare system, but just as there are signs that the pandemic may be fading, so too is the situation improving for nonprofit hospitals in particular, which are slowly recuperating from the worst effects of COVID-19.

UnitedHealth Group is investing an additional $100 million toward affordable housing initiatives with a focus on the Health and Housing Fund, a partnership with Stewards of Affordable Housing for the Future and National Affordable Housing Trust.

The Centers for Medicare and Medicaid Services is proposing a decrease in  skilled nursing facility payments by 4.6%, or $1.7 billion, in 2023 to achieve budget neutrality. As a result, there will be a decrease of approximately $320 million in Medicare Part A payments to SNFs in 2023, compared to 2022.

In a move signaling its intent to relieve medical debt burden, the Biden White House has said it would task the Department of Health and Human Services to evaluate provider billing practices, and how they factor into healthcare affordability and the accumulation of

Hackensack Meridian Health and Englewood Health, both based in New Jersey, have officially called off merger plans after a federal appeals court decision in March blocked the consolidation. 

UConn Health boosted its ROI in the revenue cycle by improving the patient billing and payment experience. Sarah Ginnetti, associate vice president, Clinical Revenue Cycle at UConn Health   worked this past year to transform the patient financial journey as the country entered the third-wave of the COVID-19 pandemic. 

Total drug spending in the U.S. grew 7.7% in 2021 compared to 2020, hitting $576.9 billion in total spend, and this trend is expected to continue, with an estimated 4 to 6% increase in national drug spending in 2022, according to a new report from the American Society of Health-System Pharmacists.

Industries are increasingly being sued by consumers for data breaches, but the sector with the biggest litigation increase is healthcare, according to new findings from the law firm BakerHostetler. In fact, healthcare comprises 23% of lawsuits due to data breaches. The next highest after that is business and professional services at 17%, followed by finance […]

Health and Human Services Secretary Xavier Becerra has announced a 90-day extension of the public health emergency that was due to expire on April 16.  The PHE is being extended for the ninth time since January 2020 due to the COVID-19 pandemic. Cases are again surging in some areas with mask mandates being implemented in […]

Providence Health & Services Washington has agreed to pay $22,690,458 to resolve allegations that it fraudulently billed Medicare, Medicaid, and other federal healthcare programs for medically unnecessary neurosurgery procedures, according to the Department of Justice for the Eastern District of Washington. 

The Department of Health and Human Services is earmarking roughly $16 million in funds to strengthen Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Programs through seven awards supporting eight states, the agency announced Wednesday. 

Trinity Health Michigan, based in Livonia, will be rebranding eight hospitals and hundreds of care sites across the state, which will all adopt the Trinity Health name and logo.

This week’s top stories include providers aiming to extend the public health emergency that ushered in waivers and flexibilities during the pandemic, and clinicians at DOD, Coast Guard and VA sites could not update medical information for hours.

UnitedHealth Group showed a slight year-to-year improvement in the first quarter of this year in posting a $5 billion profit, up from $4.9 billion in Q1 2021, according to the organization’s first quarter earnings report.

CFOs across industries are looking across their business to understand how inflation might impact their company’s financials, according to a survey of executives by asset management firm Mercer.  

The Department of Health and Human Services is launching a Community Health Worker Training Program through $226.5 million in American Rescue Plan funding.

On Friday,  Centene Corporation’s Board of Directors announced it had accepted the resignation of Leslie V. Norwalk as a member of the board. 

After a year in which the company struggled financially, Bright Health Group will be exiting six markets, and will no longer offer individual or family plans in Illinois, New Mexico, Oklahoma, South Carolina, Utah or Virginia.

Tests for COVID-19 have become all too common during the pandemic, and usually rely on a nasal swab to detect the presence of the SARS-CoV-2 virus, which causes the illness. The Food and Drug Administration however, has just granted emergency use authorization to the first-ever breathalyzer test for the virus, which can be used in […]

General acute care hospitals are projected to get a 3.2% increase in operating payment rates under the Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System proposed rule released Monday

Kaiser Permanente is joining the ranks of healthcare organizations making investments in affordable housing, pledging $400 million toward economic development and housing. This doubles the nonprofit organization’s financial commitment to its Thriving Communities social impact investment fund.

Behavioral health has grabbed a bigger share of the spotlight during the COVID-19 pandemic, in part because the emergence of remote care technologies such as telehealth that have made it easier, and somewhat less stigmatizing, to seek care for mental health. New research points to another benefit of behavioral telehealth: Certain psychiatric conditions make it […]

The American Hospital Association is “extremely concerned” that the Centers for Medicare and Medicaid Services is proposing only a 3.2% payment update for general acute care hospitals in 2023, said Executive Vice President Stacey Hughes. 

Evernorth, Cigna Corporation’s health services business, and integrated health system Kaiser Permanente are entering into a five-year collaboration for health benefit access and specialty pharmacy services. Initially, the agreement will focus on two main areas. One is access to Cigna’s PPO provider network for Kaiser Permanente members who need urgent or emergency care, and are […]

Virginia Hospital Medical Center, a community-based hospital system headquartered in Arlington, is kicking off rebranding efforts and will now be known as VHC Health, joining other organizations that have rebranded in an effort to retain or attract new market share.

The Department of Justice has filed an appeal of a judge’s order that overruled a Centers of Disease Control and Prevention requirement for mask wearing on airplanes and other public transit. The Justice Department filed the notice of appeal Wednesday in Health Freedom Defense Fund v. President Joe Biden in the U.S. District Court in […]

On Wednesday, the Centers for Medicare and Medicaid Services outlined a multi-pronged action plan geared toward promoting health equity, which will be enacted throughout the agency and will focus on access, outcomes and outreach to better serve marginalized populations.

The U.S. Department of Health and Human Services, through the Health Resources and Services Administration, is earmarking roughly $90 million in American Rescue Plan funds to reduce health disparities through new data-driven efforts for HRSA Health Center Program-supported health centers and look-alikes.

This week’s top stories include Physician Partners of America agreeing to pay $24.5M to settle a number of alleged violations, including unnecessary testing, and CMS estimates that payments to acute care hospitals will increase in 2023 by $1.6B.

Humana has signed a definitive agreement with private investment firm Clayton, Dubilier & Rice to divest a majority interest in Humana’s Kindred at Home subsidiary, KAH Hospice.  Under the agreement, Humana will divest a 60% interest in KAH Hospice and receive cash proceeds of approximately $2.8 billion. 

Optum has received approval from the Massachusetts Attorney General’s Office to go ahead with its planned purchase of Atrius Health. The AG’s office has determined that, pending judicial review by the Massachusetts Supreme Court, Atrius Health has met its requirements under Massachusetts charities law to sell its business to Optum Health and transfer its charitable […]

House Democrats are calling on the Department of Health and Human Services to end so-called “junk plans.” 

The Department of Health and Human Services and other federal agencies have filed a notice to appeal a February ruling that affects the dispute resolution process in the No Surprises Act.

Although hospitals see value in price transparency, a majority are concerned about significant challenges around deployment of CMS’ price transparency regulation, according to a KLAS survey of 66 revenue cycle leaders. The regulation stipulates hospitals must provide clear, accessible pricing estimates online for at least 300 different shoppable services.

UnitedHealth Group intends to sell the claims editing business of Change Healthcare once it acquires Change, according to an April 22 filing with the Securities and Exchange Commission. UnitedHealth Group has entered into an equity purchase agreement to sell the claims editing business, ClaimsXten, of Change Healthcare to an affiliate of investment funds of TPG […]

In the Notice of Benefit and Payment Parameters for 2023 Final Rule released today, the Centers for Medicare and Medicaid Services is finalizing standards for issuers and insurers in the Affordable Care Act marketplaces, as well as requirements for agents, brokers, web-brokers and those assisting consumers with enrollment.

Moderna announced today that it has submitted to the U.S. Food and Drug Administration a request for emergency use authorization for its COVID-19 vaccine to be given to children 6 months to under 2 years of age and for children 2 years to under 6 years of age. Similar requests are underway with international regulatory […]

Medicare Advantage Organizations sometimes delayed or denied Medicare Advantage beneficiaries’ access to services, even though the prior authorization requests met Medicare coverage rules, according to a new report by the Office of the Inspector General.

Chicago-based CommonSpirit Health has announced that Wright L. Lassiter III will succeed Lloyd H. Dean as its next CEO starting on August 1. Dean announced last fall that he would retire this year. Lassiter has been CEO of Henry Ford Health since 2016 and joined that health system as president in 2014.

The Centers for Medicare and Medicaid Services issued a final rule on Friday with policies meant to provide greater transparency for Medicare Advantage and Part D plans.  

The Massachusetts Supreme Judicial Court on Friday approved the Atrius-Optum merger. Justice Dalila Argaez Wendlandt determined the proposed transaction was in the public interest and that it was impracticable for Atrius to continue operations in its present form.

BOSTON – Aaron Maguregui, a digital health attorney at Foley & Lardner, said he gets asked all the time, “Is it OK to use pixels and cookies on a telemedicine website?” It goes to the bigger question for telehealth providers: When does data collected from a telemedicine website become patient data? Attorneys from Foley & […]

Mental health concerns keep rising among Americans of all backgrounds, especially those who are Black, young adults, older than 65 or who identify as LGBTQIA+. 

Guidewell and Highmark Ventures led a $35 million funding round for Healthmap, a kidney population health management company, joining other investors such as Windrose, DCHP and Shulman Ventures, who contributed to previous funding rounds. GuideWell is the parent of Florida Blue and Triple-S Management, the Blue Cross Blue Shield plans of Florida and Puerto Rico, […]

BOSTON – Telehealth must move forward to become not just a substitute for in-person care and a single service, but a “logistical structure” of the healthcare system, according to Roy Schoenberg, president and CEO of Amwell, a telemedicine company based in Boston.

The Supreme Court has voted to strike down Roe v. Wade, according to a draft opinion leaked to Politico. Justice Samuel Alito wrote the draft majority opinion arguing that abortion is not in the Constitution and should be left to states to decide.  The Supreme Court is expected to issue its ruling in late June or […]

Hospital operating margins showed slight improvement from February to March, but year-over-year they’re still down almost 49%, marking the third straight month in which margins lagged – suggesting that hospitals still have a long road to travel before they recover financially from the worst of the COVID-19 pandemic.

The American Hospital Association has joined the American Medical Association, AHIP and other healthcare organizations in drafting a letter to congressional leaders supporting a permanent extension of tax credits under the Affordable Care Act.

BOSTON – The metaverse, the virtual but very real convergence of technology trends, is going to change our lives as once the internet did, according to Cathy Hackl, chief metaverse officer, Futures Intelligence Group. The metaverse is the successor state to today’s internet. Think of it as Web 3.0, said Hackl, who, as an eight-year […]

Paxlovid, an oral COVID-19 antiviral produced by pharmaceutical manufacturer Pfizer, proved ineffective at preventing coronavirus infection among people living in the same house as an infected person, according to new data published by the company.

CVS Health beat industry expectations by bringing in $2.3 billion in profit in the first quarter of this year, a slight increase over the $2.2 billion profit posted during the same time last year, according to an earnings report filed this week.

Podimetrics CEO Dr. Jon Bloom talks about how home care has helped the patient experience for diabetes patients.

Drug manufacturer Johnson & Johnson has filed a lawsuit against drug benefit company SaveOnSP for allegedly taking advantage of a J&J program that covers out-of-pocket costs for patients who use some of the more expensive prescription drugs.

Medicaid managed care services are mainly concentrated across a small handful of providers, a trend that’s happening at a time when the managed care space is becoming more lucrative for health insurance providers, according to findings in a Health Affairs study published this week.

Three days after a leaked Roe v. Wade draft opinion was made public, the American Medical Association has released a statement expressing its concern over what a final ruling would mean for government interference in the patient-physician relationship.

HIMSS Director of Privacy and Security says that providers need to take a proactive cybersecurity approach to protect themselves, as well as their patients.

The U.S. Food and Drug Administration has limited the use of the  Johnson & Johnson Janssen COVID-19 vaccine due to rare blood clotting instances of thrombosis with thrombocytopenia syndrome (TTS) after receiving the vaccine.

Cigna has rolled out a new service geared toward improving health outcomes for patients with complex cancers. Powered by Evernorth, the company’s health services business, the service connects patients and their community oncologists with cancer subspecialty experts at National Cancer Institute-designated centers. The idea is that patients benefit from this connection by tapping into diagnostic […]

In two separate transactions, insurer Centene is divesting two of its pharmacy businesses, Magellan Rx and PANTHERx Rare. The company has signed two definitive agreement, and will sell the former to Prime Therapeutics and the latter to a consortium of the Vistria Group for a combined total of about $2.8 billion.

The chief information security officer emphasizes that health systems need to build their defenses amid cyber risk from the Russia-Ukraine crisis.

BOSTON – At ATA2022, BlueJeans announced the next stage in its telehealth services offerings through a more personalized experience for providers and patients.  Providers can now embed the telehealth function on their website rather than through an application, according to Krish Ramakrishnan, VP BlueJeans Strategy, Verizon Business.

Due in large part to investment losses, Kaiser Permanente posted a net loss of $961 million during the first quarter of this year, a stark contrast to the net income of $2 billion that was posted in 2021, according to financial data the organization released. In the category of other income and expense, the quarterly […]

In the last week of April, pediatric COVID-19 cases were up 61% from the period two weeks prior, according to data published by the American Academy of Physicians. Though coronavirus cases among children were still down from a peak of about 1.15 million during the height of the Omicron surge, the last week in April […]

Denise Scannell, chief scientist of health communication at MITRE says that getting factual health information facts through people’s “mental filters” is nearly impossible.  

Between 5.3 million and 14.2 million low-income people could lose Medicaid coverage following the end of the public health emergency, KFF researchers find in a

At the beginning of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services expanded telehealth coverage to patients across the country, and new data published in H

The Leapfrog Group, a national watchdog organization of employers and other purchasers focused on healthcare safety, released the spring 2022 Leapfrog Hospital Safety Grade today, finding an overall decline in patient safety measures the report considers “significant.”

The Unblock Health patient advocacy movement focuses on the administrative efforts patients face after a chronic illness or cancer diagnosis, according to Grace Cordovano, founder of Enlightening Results.  

As the United States closes in on a million deaths due to COVID-19, experts from Johns Hopkins Bloomberg School of Public Health on Tuesday weighed in on what’s next during “A New Phase of COVID-19: What Lies Ahead – from Surges to Long-Haulers.” 

A shareholder at in-home healthcare service provider LHC Group, which UnitedHealth Group subsidiary Optum is set to acquire, is suing the latter and its board of directors over the proposed merger, court docu

The past two years have been difficult for nurses, and research from Nurse.com highlights the extent to which this is true: In the “Nurse Salary Research Report,” 29% of nurses said they were considering leaving the profession, a steep rise from the 11% who were considering such a move in the 2020 survey.

GE Healthcare’s SVP and GM of Edison AI & Platform Vignesh Shetty says the company’s process can use AI and individual judgment to make great discoveries.  

The American Hospital Association and more than a dozen other provider organizations have asked Health and Human Services Secretary Xavier Becerra to keep the public health emergency until it is clear that the global pandemic has ended.

Drug manufacturer Pfizer has entered into a definitive agreement to acquire Biohaven Pharmaceuticals, a maker of migraine treatments, for $11.6 billion, the former said this week. Pfizer will also make payments at closing to settle Biohaven’s third party debt and for the redemption of all outstanding shares of Biohaven’s redeemable preferred stock. The boards of […]

There’s been a nursing shortage in the U.S. for years, but the COVID-19 pandemic has made the situation even more dire. Nurses are retiring, leaving for new roles or abandoning the profession altogether, and there aren’t enough trainees in the academic system to make up for the expected shortfall. Nursing, it would seem, is in […]

Advocate Aurora Health and Atrium Health are merging and plan to transition to the new brand, Advocate Health, the organizations have announced. The new organization will have a combined footprint across Illinois, Wisconsin, North Carolina, South Carolina, Georgia and Alabama. It will serve 5.5 million patients, operate more than 1,000 sites of care and 67 […]

Automation is essential to healthcare, according to Jan Larsson, senior advisor at Cambio Healthcare Systems. He marks Finland as a trailblazer in interoperability.

The National Institutes of Health has announced an agreement with the World Health Organization and the Medicines Patent Pool to make COVID-19 health technologies available worldwide.

The chief information officer explains the ways the New Orleans health system uses emerging technologies to achieve its goals.

After an extensive national search, Intermountain Healthcare has selected Tiffany Capeles, a nationally recognized diversity leader, to serve as the health system’s first chief equity officer, the system has announced.

The American Hospital Association and the American Nurses Association said they are grateful for the court’s leniency in sentencing former nurse RaDonda Vaught to three-years probation instead of prison time for giving the wrong drug to a 75-year old patient, who died.

Dartmouth Health and GraniteOne Health, both based in New Hampshire, are ditching their plans to merge into a single entity after objections from the state’s attorney general, who said the consolidation would result in higher healthcare prices.

Mental wellbeing in the healthcare industry needs multiple solutions, says Janae Sharp, founder of Sharp Index.  

In a partnership with Solera Health, BlueCross BlueShield of South Carolina is expanding its personalized health and wellness program to include mental and musculoskeletal health offerings. 

The Department of Health and Human Services will extend the public health emergency beyond the current end date of July 15, Bloomberg has reported.

Employers and health insurers paid hospitals about 224% above what Medicare would have paid in 2020, according to a new RAND report comparing private insurer payments to Medicare rates.

When developing and implementing AI models, it’s essential to consider a range of factors, according to UW Health physician informatics director for predictive analytics Dr. Brian Patterson.  

Under emergency use authorization, the U.S. Food and Drug Administration has expanded eligibility for the Pfizer-BioNTech COVID-19 booster vaccine to children 5 to 11 years old. People in that age group are now cleared for a single booster dose of the shot at least five months after they’ve completed the primary two-dose series.

Oscar Health shareholder Lorin Carpenter is suing Oscar Health CEO Mario Schlosser and others asking for class action status, claiming the insurer misled investors about the costs associated with COVID-19 when they bought Class A common stock in the company.

The Department of Health and Human Services is announcing a funding opportunity of nearly $15 million for a three-year federal grant to establish a Substance Abuse and Mental Health Services Administration (SAMHSA) program meant to strengthen behavioral healthcare for residents of nursing homes and other long-term care facilities.

Johns Hopkins Aramco Healthcare’s medical director of clinical informatics Dr. Tamara Sunbul on why clinician buy-in ensures that tech is aligned with user requirements.

The Pharmaceutical Research and Manufacturers of America has won its lawsuit against the Department of Health and Human Services challenging a portion of a final rule that required drug manufacturers to ensure that patient financial assistance is provided entirely

Interoperability in healthcare, it would seem, is at an important inflection point.

Anthem announced plans to rebrand as Elevance Health back in March, but one component still needed to be finalized: shareholder approval. The insurer received that approval this week, as shareholders gave the green light to the change at its annual meeting.

Corey Scurlock, MD, CEO of Equum Medical, explains the ways his company offers structure and staffing for healthcare organizations to help them with patient flow and resource use.

A Premier study shows that proposed Medicare inpatient payment updates are not keeping pace with spikes in labor costs. The PINC AI analysis shows that the proposed 3.2% hospital payment increase will not cover the more than 6.5% increase in labor rates.

In response to the ongoing opioid addiction and overdose epidemic, the U.S. Department of Health and Human Services, through the Substance Abuse and Mental Health Services Administration (SAMHSA), has rolled out a State Opioid Response (SOR) grant funding opportunity that will provide nearly $1.5 billion to states and territories.

In letters sent to Congress and the White House this week, health insurance group AHIP called for bringing transparency to what it called private equity firms’ “monopoly power” in air ambulance, emergency and certain speciality services delivered under fee-for-service.

Globant senior health informatician Dr. Camila Murga says changemakers are needed throughout organizations.

Seema Wadhwa is executive director for environmental stewardship for Kaiser Permanente. The title is relatively unique in healthcare, but not the concept. Increasingly hospitals are making green efforts as part of an overall strategy that acknowledges climate change as linked to health and health equity.

The American Hospital Association has sent a letter to the U.S. Department of Justice asking it to investigate routine denials from major health insurance companies.

In 2020, fewer than 3% of venture capital funding went to companies with Black or Latinx founders, according to  Blue Cross Blue Shield of Massachusetts. In an attempt to address these disparities, the insurer has launched a Health Equity Business Accelerator, a program meant to lend financial, strategic and mentorship support to founders of color. […]

U.S. Department of Veterans Affairs Director of Design and Storytelling Brynn Cole talks about a new program that uses knowledge of the unique understanding of the lives and healthcare needs of veterans and their families to better serve them.  

Monkeypox has been reported among five men in four states: Massachusetts, New York City, Florida and Utah, which has reported two individuals infected. All of the cases reported in the United States involve recent travel outside of the United States. In the case in Massachusetts, the man traveled to Canada.  President Joe Biden said Sunday, “it […]

With a projected shortage of nearly 140,000 physicians by 2033, and a shortage of three million lower-wage healthcare workers in the next five years, U.S. Surgeon General Dr. Vivek Murthy has sounded the alarm on the country’s ongoing healthcare burnout crisis.

California Governor Gavin Newsom signed legislation this week increasing the monetary awards given to patients in medical malpractice cases in the state. Newsome touted the legislation as the first substantive change to California’s medical malpractice system in decades.

nThrive president and CEO Hemant Goel gives tips for CFOs and RCM executives looking to make a change in end-to-end RCM.  

After a nationwide search, Dr. Christina Harris has been named Cedars-Sinai’s VP and chief health equity officer.

A survey by AHIP and the Blue Cross Blue Shield Association shows The No Surprises Act, which was passed with the intent of preventing surprise medical bills, has lived up to that goal by preventing more than 2 million surprise medical bills across all commercially insured patients. The analysis also found that should this trend […]

Almost half of respondents to a new survey, 44%, say they have avoided getting healthcare services because they were unsure of the costs.

Bettina Hein and Bettina Duehrkoop, cofounders of chronic condition management app Juli, discuss the startup’s recent seed raise.

Geisinger has announced that it has chosen Amazon Web Services as its strategic cloud provider.  The decision comes after a detailed multi-year review and selection process that identified transitioning to AWS will help save the health system several million annually after implementation is completed, Geisinger said. 

The New York Attorney General has filed suit against the Roman Catholic Diocese of Albany, claiming the latter mishandled pensions for retirees of St. Clare’s Hospital, thereby allegedly dodging its financial and legal responsibilities.

The Centers for Medicare and Medicaid Services has approved California, Florida, Kentucky and Oregon to expand Medicaid and Children’s Health Insurance Program coverage to up to one year postpartum – bringing the total number of states expanding postpartum Medicaid coverage to 11. CMS estimates this would affect a total of about 126,000 families annually across […]

AVIA’s Cynthia Perazzo and Alex Bacchetti say that we can learn from the pandemic era and supplement the workforce through technology to reduce strain.

The Department of Health and Human Services has withdrawn a Trump-era rule that mandated the sunset of any rule more than 10 years old unless it was reviewed within five years.

The Senate Finance Committee, led by Chair Ron Wyden (D.Ore.), is seeking to make permanent some of the telehealth flexibilities enacted during the COVID-19 pandemic that pertain to mental health services.

In a statement this week directed at the Centers for Medicare and Medicaid Services, the Leapfrog Group urged the federal agency to nix a proposal that would put an end to the public reporting of data on medical and surgical complications.

Medicare beneficiaries are expected to see lower Part B premiums in 2023 due to the lower price of Alzheimer’s drug, Aduholm. Today, Department of Health and Human Services Secretary Xavier Becerra said 2002 Medicare Part B premiums should be adjusted downward due to the drug manufacturer reducing the price of Aduholm from $56,000 per year […]

The chief digital and information officer explains how the organization deployed ambient voice technology across varied departments in order to speed documentation and ease the burden for clinicians.

In a letter to the Department of Health and Human Services, California Senator Diane Feinstein asked the agency to reverse a decision by the Centers for Medicare and Medicaid Service

Despite more than $3 billion in revenue during the first quarter, the Cleveland Clinic saw a $282 million loss in the three-month period ending March 31, largely due to rising expenses, according to the system’s recently released financial documents.

More than two years after being on the front lines of the COVID-19 pandemic, hospitals and health systems continue to struggle financially due to its effects, according to Kaufman Hall’s National Hospital Flash Report.

The Department of Health and Human Services has announced it is establishing an Office of Environmental Justice to help protect the health of disadvantaged communities and vulnerable populations on the frontlines of pollution and other environmental health issues. 

After a strong first quarter, health insurers can expect earnings growth and a stable credit outlook, Moody’s Investors Service has found. Average earnings growth before interest, taxes, depreciation and amortization growth in the first quarter was 3.7% among seven publicly traded health insurers, said Moody’s new report.

Kaiser Permanente is establishing a new Center for Gun Violence Research and Education that will focus on gun violence prevention, part of the health system’s response to shootings in Uvalde, Texas and elsewhere.

The founder of Techmedo, Zahid Ali, says the pandemic has caused changemakers to rise to the occasion.

Due to the Medical Loss Ratio provision of the Affordable Care Act, health insurers will issue roughly $1 billion in rebates to customers in 2022, according to a new

In an effort to improve care for children with special healthcare needs, the Department of Health and Human Services has released “The Blueprint for Change: A National Framework for a System of Services for Children and Youth with Special Health Care Needs” through a special supplement in the journal Pediatrics.

Five people are dead, including the gunman, in a shooting that took place at an orthopedic clinic on the campus of Saint Francis Hospital in Tulsa, Oklahoma, according to numerous reports.  Two orthopedic surgeons, a medical office staffer and a patient were killed late Wednesday afternoon by a gunman who had been a patient of […]

Cherish Health employs ambient sensing for remotely monitoring aging patients without cameras or wearables, explains Sumit Nagpal, the CEO and founder.

There is broad-based and bipartisan support for continuing telehealth flexibilities allowed during the pandemic, but so far Congressional action has been limited. Several bills have been introduced in both the House and the Senate.

In another attempt to halt a healthcare merger, the Federal Trade Commission has sued to block the acquisition of Saint Peter’s Healthcare System by RWJBarnabas Health, one of New Jersey’s largest hospital systems.

Calling the health systems rival competitors in Utah, the Federal Trade Commission has brought an administrative complaint and a lawsuit in federal court to block the proposed merger between HCA Healthcare and Steward Health Care System.  The agency said the deal would eliminate the second and fourth largest healthcare systems in the Wasatch Front region, […]

The Hospital Insurance Trust Fund, or Medicare Part A, which helps pay for services such as inpatient hospital care, will be able to pay scheduled benefits only until 2028, according to a new report from the Trustees of the Social Security and Medicare trust funds. While that’s two years later than was originally reported last […]

Kyruus’s Scott Andrews and HealthSparq’s Harlan Edlin talk about improving patient engagement for organizations.

Loneliness: It was a widespread problem in the U.S. before the pandemic, but COVID-19 made it worse, forcing people into isolation and social distancing protocols. It’s been one of the biggest motivators behind the push for increased access to mental health services, and a new poll from Morning Consult and Cigna shows more than half […]

Health insurer Humana is adding 14 states to its ongoing initiative to rebrand the home health division of Kindred at Home as CenterWell Home Health. KAH home health services have already begun transitioning to the CenterWell brand in a number of other states, with Phase 2 bringing the total up to 21 states overall.

Mitre’s chief digital health physician, Dr. Brian Anderson, explains the process of developing SMART Health Cards.  

The Cleveland Clinic’s virtual second opinions program has led to avoidable costs for misdiagnosis of about $65 million annually. This is an estimated $65 million saved per 100,000 health plan members, said Frank McGillin, CEO of The Clinic by Cleveland Clinic. Typically, the virtual second opinion is a premium benefit health plans are offering, he […]

Insurer group AHIP has come out in favor of a proposed rule from the Treasury Department and Internal Revenue Service to tweak a “family glitch” in the Affordable Care Act, provided health plans receive timely guidance on the requirements.

The American Hospital Association supports the Centers for Medicare and Medicaid Services’ proposal to delay the January 2023 start of the Radiation Oncology Model to a date determined through future rulemaking, the association told the agency today.

Jamie Reedy, Summit Health’s chief of population health explains how the company’s data strategy supports Medicare ACOs and over 30 value-based contracts.

Hospitals will experience a slowing of inpatient admissions but an increase in the length of adult inpatient stays, the latter being fueled in part by long COVID-19 and a rise in chronic conditions, according to a new report from Vizient and its subsidiary Sg2. 

A policy that would cap cost sharing at $5,000 for traditional Medicare would reduce cost sharing for enrollees with the greatest healthcare needs by about 53%, according to data published this week by the Urban Institute.

The Federal Trade Commission is requiring the six largest pharmacy benefit managers to provide information and records regarding their business practices. The agency is launching an inquiry into what it called the prescription drug middleman industry to scrutinize the impa

Health insurer Anthem, which will switch its branding to Elevance Health on June 28, has partnered with Happify Health to digitally address the physical and mental health of women. Anthem framed the move as a means of supporting women through their maternal health journey through solutions such as ongoing education, case management and care coordination. […]

The U.S. Department of Health and Human Services, through the Health Resources and Services Administration, is investing close to $15 million in 29 organizations in rural communities to address psychostimulant misuse and related overdose deaths. 

In the next three years the country plans to be “best in the world” at using IT to boost health outcomes, according to Maria Hassel of the Swedish eHealth.

A number of pharmaceutical groups have come out in favor of the Federal Trade Commission’s decision to launch an inquiry into the business practices of the nation’s six largest pharmacy benefit managers, in order to scrutinize their impact on the access and affordability of prescription drugs.

The United Health Foundation, the philanthropic arm of UnitedHealth Group, is making a $100 million commitment over 10 years to advance health equity, in what it framed as a continuation of its efforts to eliminate health disparities. The new commitment was announced today at the Social Innovation Summit in Washington, D.C., by Patricia L. Lewis, […]

Private practices can use digital transformation to ensure healthcare data quality and also compete with retail clinics, according to Oleg Bess, MD, an OB-GYN at Women Center L.A.

Heart failure patients who are unvaccinated against COVID-19 are three times more likely to die if infected with the virus compared to fully boosted heart failure patients, according to new research out of Mount Sinai Heart.

The American Hospital Association has urged the Centers for Medicare and Medicaid Services to extend enforcement discretion for the No Surprises Act regulatory requirement that healthcare providers exchange certain information to create a good faith estimate for uninsured and self-pay patients – until the agency identifies, and providers can implement, a standard, automated way to […]

Two hospitals in Georgia, both part of the Northside health system, have become the first facilities to be fined by the Centers for Medicare and Medicaid Services for noncompliance with federal price transparency rules that went into effect last January. The two hospitals, Northside Hospital Atlanta and Northside Hospital Cherokee, were fined a combined $1.1 […]

Technology Solutions Consulting’s CEO and president Alfred Hamilton discusses the range of data available to consumers that helps them make decisions health and why the pandemic has changed the industry.

The American Medical Association is praising a bipartisan gun proposal that would give grants to states for red flag laws, provide spending for mental health treatment and school security and give extra scrutiny for gun buyers under the age of 21, according to Politico

Health system Providence has launched software analytics company Advata by combining KenSci, Colburn Hill Group, Lumedic and three other companies. The new firm will focus on revenue cycle management solutions back-office management, population health and clinical decision support.  

The Department of Health and Human Services, through the Health Resources and Services Administration, is launching the Building Bridges to Better Health: A Primary Health Care Challenge.

AltaMed Health Services SVP and CIO Ray Lowe talks about the evolution of virtual care since his organization set it up at the beginning of the COVID-19 pandemic.  

A spotlight has been put on Medicare Advantage denials for claims and pre-authorizations since an Office of the Inspector General report that found MA plans denied requests that met original Medicare coverage rules.

Physicians at Corona Regional Medical Center and Temecula Valley Hospital in California have threatened to leave the hospitals if for-profit owner Universal Health Services changes the staffing management firm to Envision Healthcare, according to an emergency room doctor who heads the hospitals’ current staffing firm.

Atropos Health cofounder, board chair and CEO Brigham Hyde believes in using research data to deliver insights patients can act on.  

The American Hospital Association is urging Congress to prevent the Medicare sequester cuts to hospitals that are scheduled to go into effect on July 1.  

Grant Thornton chief economist Diane Swonk talks about how employers can improve the mental and physical health of staff to avoid burnout.  

The Supreme Court on Wednesday handed up a ruling in favor of hospitals’ claims to 340B drug reimbursement, but left questions for providers as to how they will be made whole for the two years they didn’t receive billions from the Department of Health and Human Services, or what comes next.

Managed care company Centene has agreed to pay $13.7 million to New Mexico to settle an investigation into its subsidiaries’ inflationary pricing and reporting of pharmacy benefits in the state’s Medicaid program, which is overseen by the state’s Human Services Department.  

Anthem is relaunching its Wellpoint brand to unify its Medicare, Medicaid and commercial health plans in select markets.

Pharmacy retail giant Walgreens announced the launch of a clinical trials business with the aim of boosting access and retention in sponsor-led drug development research by engaging broader and more diverse communities.  

With telehealth laws now receiving federal attention, it is imperative that organizations are fully equipped to make virtual care a permanent part of their practice. Regulatory compliance, the right technology strategy and proper training are some of the backend operations that organizations need to consider to not only optimize virtual care, but to standardized care […]

President and CEO of Canada Health Infoway Michael Green discusses telehealth taking hold after the pandemic and its assistance in getting kids mental healthcare.

The Centers for Disease Control and Prevention has now cleared the way for children six months through five years old to receive a COVID-19 vaccine, following a recommendation from the Advisory Committee on Immunization Practices’.

The Centers for Medicare and Medicaid Services estimates that Medicare payments to home health agencies in 2023 would decrease in the aggregate by 4.2%, or $810 million, compared to 2022, in its 2023 Home Health Prospective Payment System Rate Update

There are significant inaccuracies in Medicare data on race and ethnicity, which is especially troublesome given that the Centers for Medicare and Medicaid Services is looking to collect such data from providers and payers, according to the Department of Health and Human Services’ Office of the Inspector General.

Provider compensation increased in 2021 as the volume of services rose again to pre-pandemic levels, according to a report from AMGA Consulting (American Medical Group Association).

Castell’s chief analytics officer Andrew Sorenson discusses the wider applications of value based care for providers.

Health Services firm Optum UK, a subsidiary of UnitedHeath Group, will acquire U.K.-based healthcare technology company EMIS for about $1.51 billion, the latter has announced.

Forty percent of employees responding to a new survey from Willis Towers Watson said they deferred medical care over the past year, including 28% who delayed or canceled a medical procedure or appointment. At the same time, 17% failed to fill at least one prescription, while 20% said their healthcare provider delayed or canceled a […]

In a 7-2 decision, the Supreme Court has sided with a health plan over its coverage for outpatient dialysis services. Major dialysis service provider DaVita had sued the Marietta Memorial Hospital Employee Health Benefit Plan claiming its limited coverage violated the statute.

Total 2023 payments to all end-stage renal disease facilities would increase 3.1%, compared with 2022, under the End-Stage Renal Disease Prospective Payment System proposed rule that the Centers for Medicare and Med

CVS Health will be expanding its Project Health program, which provides free, community-based health screenings, by moving into two new geographic regions – Las Vegas, Nevada and Richmond, Virginia.

About 253,000 parents have gained access to 12 months of postpartum coverage through Medicaid and Children’s Health Insurance Program extensions, according to data from the Department of Health and Human Services. It’s part of the current administration’s push to address maternal mortality and morbidity.

About 253,000 parents have gained access to 12 months of postpartum coverage through Medicaid and Children’s Health Insurance Program extensions, according to data from the Department of Health and Human Services.

President of Bluestream Health Brian Yarnell explains the ways the company works with healthcare systems to increase equity for patients in underserved populations through virtual health front doors.  

Former Optum executive Matt Nyquist has joined Lifespark as its chief population health officer and will lead the design, development and management of the company’s global risk products and market expansion. In an announcement, Lifespark framed the move as a push to reduce costs for seniors and providers.

Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure is pushing for Congress to extend Affordable Care Act tax subsidies made possible by American Rescue Plan funds. The subsidies are scheduled to expire at the end of 2022. 

Optum announced it’s launching a laboratory benefit management solution designed to help health plans reduce unnecessary lab testing and ensure their members receive appropriate, high-quality tests. The potential savings for health plans range from $12-36 per member per year – or more than $3 billion annually, Optum said. The offering is designed to help health […]

VP and general manager of Google for Clinicians, Paul Muret, and Aashima Gupta, Google Cloud’s director of global healthcare solutions, talk about how Google is working on tools for clinicians that help them make better healthcare decisions.

The U.S. Supreme Court has declined to hear UnitedHealthcare’s challenge to a federal rule stipulating insurers offering Medicare Advantage plans refund payments based on unsupported diagnoses in patients’ medical records.

The Supreme Court has overturned 49 years of a women’s constitutional right to an abortion in siding today with Mississippi Department of Health Officer Thomas E. Dobbs in Dobbs v. Jackson Women’s Health Organization.

Today’s Supreme Court ruling striking down Roe v. Wade has implications for health insurance coverage, according to healthinsurance.org. The 6-3 ruling that unwinds close to 50 years of a woman’s right to an abortion now leaves that decision to individual states. An estimated half of them already have abortion restrictions in place or are expected […]

Health First’s Sean Michaels discusses how to face common challenges to effective diversity, equity and inclusion initiatives.  

Meta Platforms is facing a potential class-action lawsuit for allegedly using its Pixel tracking tool to get patient information from hospital portals for target marketing purposes.

The American Hospital Association’s reaction to Friday’s Roe v. Wade decision overturning close to 50 years of abortion rights was brief and lacking the emotion of other statements by health leaders.

The heads of the Department of Health and Human Services, Labor and the Treasury Departments have put health plans and issuers on alert over contraception coverage under the Affordable Care Act.

 The Center for Medicare and Medicaid Innovation has designed a new model aimed at improving cancer care for Medicare patients through enhanced services such as patient navigation, care planning and the collection of electronic patient-reported outcomes.

The Center for Medicare and Medicaid Innovation has designed a new model aimed at improving cancer care for Medicare patients through enhanced services such as patient navigation, care planning and the collection of electronic patient-reported outcomes.

E-prescribing software developer Dr. First has announced a free Huddle Health app that allows patients to receive and share their medical records. The app allows users to collect and share records from their health history, including past and current medication lists, care plans, and provider and insurance information, the company said. 

The federal government will do all it can to protect Americans’ reproductive rights but there is no “magic bullet” to Friday’s Supreme Court ruling overturning Roe v. Wade, Health and Human Secretary Xavier Becerra said on Tuesday. HHS will support access to medication abortion, safe travel to states that allow abortions and health privacy.

The U.S. Department of Health and Human Services has announced an enhanced nationwide vaccination strategy against monkeypox.  The strategy will prioritize vaccines for areas with the highest numbers of cases, and provide guidance to state, territorial, tribal, and local health officials to aid their planning and response efforts, HHS said.

The U.S. Supreme Court on Monday declined to hear a case over whether pharmacy benefit managers must act in the interest of Employee Retirement Income Security Act self-funded plans by lowering drug costs.

Healthcare tech consortium Synaptic Health Alliance has announced the addition of its newest member, ProCredEx, a blockchain health credentialing company.   The Alliance also announced the expansion of its provider data management initiative to Colorado, Florida, Michigan, and New York.  

More than 60 health leaders have joined a Biden Administration initiative in pledging to reduce greenhouse gas emissions by 50% by 2030. This represents over 650 hospitals, according to the Department of Health and Human Services, which made the announcement on Thursday. 

1upHealth CSO Don Rucker, MD, and CEO Joe Gagnon highlight how crucial interoperability is, and how the company helps unlock data in healthcare for payers, providers and patients via FHIR conversion.

The Centers for Medicare and Medicaid Services has proposed a new rule that creates a pathway for rural hospitals and critical access hospitals to increase access to emergency and outpatient care. It is the first step in the implementation of a new provider type, Rural Emergency Hospitals (REHs). 

More than eight in 10 healthcare executives expect the metaverse to have a positive impact on the healthcare industry, according to a report from Accenture.  

Aetna is no longer requiring precertification for cataract surgery. Aetna is rolling back on policy it announced last year and is no longer requiring pre-approval for cataract surgeries, except for people enrolled in Medicare Advantage plans in Florida and Georgia. 

Financial planning, performance and analysis is what CFOs want to do, but much of their time is spent moving data around, according to Frank Stevens, vice president of Financial Planning at Strata Decision Technology.

Highmark Health, the integrated health network and Allegheny Health Network, which is part of Highmark, have collaborated with Cedar Health to improve the patient’s financial journey in a program slated to go-live in September.

Jason Considine, Experian Health chief commercial officer, said regulations around price transparency and the No Surprises Act were among the topics discussed at the Healthcare Financial Management Association annual conference in Denver last week. Both regulations are creating challenges, he said.

Lawmakers from the U.S. House of Representatives are asking the Centers for Medicare and Medicaid Services to expand the definition of medically necessary dental coverage for Medicare beneficiaries, saying the agency currently has the regulatory authority to do so.

b.well Connected Health CEO Kristen Valdes talks about how healthcare organizations can use data can lead to better communication with patients that keeps them engaged.

The federal government is making a push to expand residency programs, with the Department of Health and Human Services announcing more than $155 million in awards for 72 teaching health centers that operate primary care medical and dental residency programs. These programs will include high-need specialties such as psychiatry.

The annual rate of uninsured children fell from 5.1% in 2019 to 4.1% in 2021, representing about 700,000 fewer uninsured children during the COVID-19 pandemic, according to new data released by the Urban Institute.

Dr. Paul Garassus, president, European Union of Private Hospitals, says trust and efficient investments can sustain healthcare delivery by putting the patient at the center of connected care.    

Several factors are expected to impact premiums in 2023, including global inflation, the lingering effects of COVID-19 and the end of enhanced subsidies for plans on the exchange, according to a new report from the American Academy of Actuaries.

Cigna has divested its Asia-based life, accident and supplemental benefits business, selling it to Chubb in a transaction estimated at about $5.4 billion. Cigna chairman and CEO David M. Cordani said the transaction allows the insurer to focus on growing its global health portfolio.

State and local governments are needed in carrying out successful maternal and infant health policy, according to Uma Ahluwalia, managing principal at Health Management Associates.  

COVID-19 was the leading cause of death for people between the ages of 45 and 54 in 2021, accounting for 16.8% of all deaths in that age group, found a study in JAMA Internal Medicine. It was the third leading cause of death during the height of the pandemic in 2020, surpassed only by cancer […]

Senate Democrats have carved out a deal on legislation that would attempt to lower prescription drug costs for Americans by allowing Medicare to negotiate for lower drug prices.

The U.S. Food and Drug Administration on Wednesday revised the Emergency Use Authorization for Pfizer’s antiviral COVID-19 treatment Paxlovid, allowing pharmacists to prescribe the treatment, with limitations. Paxlovid is authorized for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients 12 years old and older who are at high risk for progression to severe […]

The Department of Health and Human Services, through the Centers for Medicare and Medicaid Services, has released a suite of resources meant to improve CMS and state oversight of Medicaid and Children’s Health Insurance Program managed care programs – which provide people with health benefits and additional services through contracted arrangements with managed care plans.

CIO of Governor Juan F. Luis Hospital in the Virgin Islands Gregory Bryant explains how the pandemic changed workflow and offers tips on dealing with cybersecurity attacks.  

The Centers for Medicare and Medicaid Services has issued the 2023 Physician Fee Schedule (PFS) proposed rule, which seeks to expand access to behavioral health services, Accountable Care Organizations, cancer screening and dental care, with a focus on rural and underserved ar

One in five adults in the U.S. have received an unexpected medical bill this year, even after a federal ban on surprise medical billing, according to a new survey from Morning Consult. 

Employers of all sizes are looking to bolster their health benefit options in 2023 with an eye toward improving recruitment and retention, and will focus on affordability and access, according to a new Mercer survey.

Oncology AI company Ronin vice president of data science Christine Swisher gives thoughts on  the continuous monitoring of model performance, “garbage in, garbage out,” provider-facing dashboards and “AI drift.”  

In a bid to make diabetes treatment more affordable, California Governor Gavin Newsom said in a  recent Twitter video that the state will begin making its own low-cost insulin, using a $100 million budget to kick-start development and manufacturing of the drug.

The federal government recovered more than $5 billion in healthcare fraud settlements and judgments in fiscal year 2021, according to the joint annual government Health Care Fraud and Abuse Control Program Annual Report from the of the Departments of Justice and Health and Human Services.

Signify Health, a value-based care-focused analytics platform, will be ceasing its Episodes of Care Services (ECS) business and exiting the Centers for Medicare and Medicaid Services’ Bundled Payments for Care Improvement-Advanced (BPCI-A) model, the company announced.

According to Moffitt Cancer Center’s vice president of digital innovation, Santosh Mohan, oncology providers and startups can work together to improve the patient and clinician experience.

CVS Health has named Tilak Mandadi as executive vice president and to the newly created role of chief data, digital and technology Officer. The company said Mandadi’s tenure in the new roles will begin on July 25. Mandadi will be responsible for the company’s data, digital and technology strategy while overseeing growth and innovation, according […]

The federal government under the Biden Administration has made a push to ensure abortion access as part of emergency medical care, with Health and Human Services Secretary Xavier Becerra telling providers this week that pregnant women and others experiencing pregnancy loss have access to “full rights and protections” for emergency care under federal law.

There is a low risk of transmission of monkeypox in healthcare settings, according to a June study published in Infection Control & Hospital Epidemiology.

New legislation introduced in the U.S. House of Representatives seeks to avoid a shortfall in the Medicare Hospital Insurance Fund by closing tax loopholes and redirecting tax revenue in a push to keep the fund solvent by at least another decade.

The U.S. Department of Health and Human Services, in collaboration with the Department of Defense, announced it has secured 3.2 million doses of Novavax’s COVID-19 vaccine.  The protein-based, adjuvanted vaccine will be made available for free to states, jurisdictions, federal pharmacy partners and federally qualified health centers if it receives U.S. Food and Drug Administration […]

In order to help discriminated groups and reduce health disparities, key stakeholders must show “amazing leadership and be incredibly brave,” in helping disadvantaged groups and reducing disparity in healthcare, according to Steve Gilbert, a serious mental illness living experience consultant and anti-racism advisor.

The American Medical Association has criticized the new Medicare payment schedule proposed rule released last week by the Centers for Medicare and Medicaid Services, saying it fails to account for inflation in practice costs and “COVID-19-related challenges to practice sustainability.”

Los Angeles Mayor Eric Garcetti signed an ordinance into law which raises the minimum wage for healthcare workers to $25 per hour at eligible private healthcare facilities. 

UnitedHealth Group’s provider arm, Optum Health, has teamed up with Red Ventures on a new consumer health-focused joint venture, RVO Health, which among other things includes doctor ratings through Healthgrades. Red Ventures is a portfolio of bands that includes Healthgrades, Healthline Media, Optum Perks and Optum Store, as well as virtual coaching programs. Those will […]

Digital health and patient expert Birgit Bauer discusses the core aspects of the Gravitate Health project and her role in the project’s user advisory group.

Beginning this week, Mayo Clinic Laboratories will begin testing for monkeypox using the Centers for Disease Control and Prevention’s orthopoxvirus test, which detects most non-smallpox related orthopoxviruses, including monkeypox.

Just days after the Biden Administration advised providers that abortions are protected under the federal Emergency Medical Treatment and Labor Act, the Department of Health and Human Services has released guidance saying that as recipients of federal financial assistance – incl

Blue Cross and Blue Shield of North Carolina is joining forces with Headway, a mental health company that works with insurers to deliver behavioral healthcare, to address what it sees as a serious problem: A shortage of mental health professionals in the state. BCBS said the partnership will make it easier for Blue Cross NC […]

Los Angeles Mayor Eric Garcetti signed an ordinance into law that raises the minimum wage for healthcare workers to $25 per hour at eligible private healthcare facilities. 

Simon Bolton, CEO at NHS Digital, explains a new program to improve the digital capabilities of hospital trusts, and how to take people with you in its realization.

About 22% of revenue cycle leaders who manage their inpatient revenue cycle management already outsource some of their outpatient RCM, and 12% have ambitions to do so in the future, finds a new survey conducted by the Healthcare Financial Management Association.

UnitedHealth Group posted $5.1 billion in profits while raking in $80.3 billion in revenues in the second quarter of the year, showing 13% growth year-over-year, driven by double-digit growth at Optum and UnitedHealthcare, the company’s provider and insurance arms.

Healthcare mergers and acquisitions had a banner quarter in the second quarter of this year, with a record high of $19.2 billion in total transacted revenue, driven by a couple of “megadeals” that led to double the transacted revenue posted in Q1.

As enrolment in the Medicare Advantage (MA) program grows, so are concerns and uncertainly over the profits providers are reaping and whether or not “overpayment” is an issue. 

The Centers for Medicare and Medicaid Services is proposing actions meant to advance health equity and improve access to care in rural communities by establishing policies for Rural Emergency Hospitals (REH) and providing for payment for certain behavioral health services furnished via communications technology. 

Hannah Galvin, MD, chief medical information officer at Cambridge Health Alliance, discusses implementing patient privacy, interoperability and health equity by balancing granular data segmentation and patient-driven consent-management tools.  

On the heels of a strong financial quarter in Q2, UnitedHealthcare has said it will eliminate out-of-pocket costs for insulin and other medications for eligible members, offering a zero cost share for five drugs in its fully insured group plans. Pending regulatory approval, this could take effect as soon as January 1, 2023.

The federal government has ordered another 2.5 million doses of Bavarian Nordic’s JYNNEOS vaccine to respond to the current monkeypox outbreak. This follows a July 1 order for 2.5 million doses that will begin arriving in the Strategic National Stockpile (SNS) over the next year.

Rhonel Cinous serves on the Tech Access Group of the United Spinal Association. He explains the centrality of accessibility for connected health innovations.

The State of Texas has sued the Department of Health and Human Services over its mandate is

The American Hospital Association is disappointed with the federal government’s 2.7% payment increase for outpatient care, given continued financial challenges.

Clinicians from states affected by mass shootings convened at a consensus conference last fall to discuss an appropriate response to such events, and have just released a number of recommendations they hope will facilitate a better response to mass shootings from the healthcare industry, including readiness training and public education.

Clover Health has become the latest insurer to expand its Medicare Advantage footprint, and will push into 13 new counties across three states in 2023: Georgia, South Carolina and Tennessee. Subject to approval from the Centers for Medicare and Medicaid Services, those eligible for Medicare in these new counties will be able to sign up […]

Access to data can offer improved patient journeys, according to Hassan Chaudhury, interim commercial director for the U.K.’s Health Data Research Hub for Cancer.  

The Pharmaceutical Research and Manufacturers of America is funding a clinical trial initiative to enhance diversity, which has been an ongoing problem in the development of new drugs. The initial $10 million grant will fund an 18-month pilot at ten community sites located in the southern United States.

Elevance Health, formerly known as Anthem, logged a $1.7 billion profit during the second quarter of this year, and while that’s down almost 8% compared to Q2 2021, revenues for the quarter were up, which the company attributes to increased enrollment. Overall, Elevance beat industry expectations with double-digit growth in revenue, operating earnings, and adjusted […]

The administration made a push to expand healthcare coverage for young people this week when the U.S. Department of Health and Human Services, through the Centers for Medicare and Medicaid Services, awarded $49 million to organizations trying to reduce uninsured rates among children, parents and families.

Smile CDR CEO Duncan Weatherston explains how Smile, a FHIR-based enterprise data platform, helps researchers, payers and providers and manage data from various sources.

Due to what it called unprecedented net operating losses, Providence, the not-for-profit Catholic health system serving seven states in the western U.S., is grouping its existing seven regional senior leadership teams into three divisional teams. The new operating model calls for a leaner executive team, according to Providence, which did not specify the number of […]

Adding to the hardship on victims and their families, gun violence injuries in the U.S. cost more than $1 billion each year in initial direct medical costs alone, a federal committee has found.

The COVID-19 pandemic has been hard on nonprofit hospitals, and without action to address upward pressure on their expenses, the hardships are likely to continue, according to a market update from Fitch Ratings.

Nirav Shah, MD, Medical Director of Quality Innovation for NorthShore University HealthSystem, explains the use of informatics and technology to fuel innovation for personalized remote care.

The Centers for Medicare and Medicaid Services has released the first-ever home- and community-based services quality measure set to promote consistent quality measurement within and across state Medicaid home and community-based programs.  The measure set is intended to provide insight into the quality of HCBS programs and enable states to measure and improve health outcomes for […]

Increasingly, consumers are growing dissatisfied with their current digital experiences in healthcare, saying they would prefer a more seamless means of scheduling and interacting with their provider or health plan.  According to a new survey from UnitedHealth Group subsidiary Optum, providers and payers could improve patient satisfaction by offering tools such as a digital “front […]

Existing diabetes quality metrics do not currently help patients improve their health and diabetes quality measurement must be improved through the adoption of new measures and modernization, according to a June report published in Health Affairs.  

Dr. Joel Diamond of 2bPrecise talks about precision medicine moving into the mainstream, including pharmacogenomics in primary care and genetic insights for specialty care.  

The World Health Organization has declared monkeypox a public health emergency of international concern. WHO Director General Tedros Adhanom Ghebreyesus made the declaration on Saturday, the day after United States health officials said the Department of Health and Human Services is considering its own public health emergency for monkeypox.

If the enhanced subsidies on the Affordable Care Act’s exchanges were extended on a permanent basis, there would be just shy of 5 million new signups annually, according to a letter sent to the Senate Finance Committee by the Congressional Budget Office.

Confidence in the security and confidentiality of personal health information is beginning to erode, if the results of a new survey are any indication. Released by the American Medical Association, it showed that more than 92% of patients believe privacy is a right, and their health data should not be available for purchase.

The effects of the COVID-19 pandemic on the healthcare industry have been profound, resulting in shifting profit pools, spikes in innovation, and the creation of new business models, while diversification and vertical integration are likely to accelerate in the pandemic’s wake.

Mark Martin, vice president of product management for Availity, discusses how the company employs AI and machine learning to assist providers and payers in streamlining referrals, approvals and claims management.  

In another round of divestitures, Centene will be selling off its Spanish and central European businesses to French hospital operator Vivalto Santé for an undisclosed sum, in a transaction expected to close before the end of the year.

Acute and behavioral hospital operator Universal Health Services saw higher revenue in the second quarter but a much lower profit, with profits dipping by half compared to its quarterly performance in Q2 2021, according to financial documents released by the company this week.

Georgi Chaltikyan, MD, professor and head of digital health at Deggendorf Institute of Technology, advocates coordinating and streamlining the work of creating a digital health workforce.  

The Purchaser Business Group on Health has announced a new, primary care agreement with five large payer organizations and a provider serving California.

Ahead of the Centers for Medicare and Medicaid Services releasing the final rule on inpatient payment, House and Senate members are urging CMS to increase the rate hospitals will be paid.

As part of the Biden Administration’s bid to improve health outcomes and reduce disparities for people during and after pregnancy and childbirth, the Centers for Medicare and Medicaid Services has announced a Maternity Care Action Plan – saying it will take a more holistic and coordinated approach to such care.

In a move meant to simplify its organizational structure, Humana will pare itself down into two main units, Insurance Services and CenterWell, while launching an executive search for president of insurance and enterprise services.

Dr. Justin Norden, partner at GSR Ventures, talks about takeaways from Rock Health’s H1 2022 digital health funding report, and how startups in mental health continue to grab investor interest.

The Centers for Medicare and Medicaid Services has finalized three rules for hospice care, inpatient psychiatric facilities and inpatient rehabilitation facilities. WHY THIS MATTERS: PAYMENT INCREASES Hospices The 2023 hospice payment update is 3.8%, which is expected to result in an increase of $825 million in payments from 2022.

The House passed a bill on Wednesday that extends telehealth flexibilities under Medicare that were initially authorized during the public health emergency of COVID-19. The House of Representatives passed H.R. 4040, Advancing Telehealth Beyond COVID-19 Act of 2022. It now moves to the Senate for approval.

The House Ways and Means Committee on Wednesday convened a markup session regarding a bipartisan bill, “Improving Seniors’ Timely Access to Care Act of 2022,” which seeks to modernize the way Medicare Advantage plans and healthcare providers use prior authorization.

Adjusted for inflation, healthcare spending in the U.S. declined for the first time in more than half a century in 2021, according to a new report from Altarum.  The first time the Centers for Medicare and Medicaid Services officially tracked health spending was in 1960, and since that time growth in national health spending has […]

Of 3,093 hospitals rated, 429 earned 5 stars in the Centers for Medicare and Medicaid Services 5-star rating system. This compares to an estimated 455 hospitals when the previous ratings were last released in April 2021. In the latest ranking, many large health systems had hospitals on the 5-star list.

The HIMSS Asia-Pacific Conference is happening in Bali on 27 – 28 September, 2022. HIMSS interviewed key stakeholders in Indonesia about pandemic challenges and the ways digital technology has transformed care delivery.                                                                                                                                                                            

The U.S. Department of Health and Human Services and the Departments of Labor and Treasury are taking action to clarify protections for birth control coverage under the Affordable Care Act.  The departments have issued guidance on access to emergency contraceptives, emphasizing their commitment to enforcement.  

The Centers for Medicare and Medicaid Services is looking for ways to make Medicare Advantage better. The agency has released a Request for Information seeking public comment on the popular offering, and is seeking input on ways to make it more equitable, affordable and sustainable.

The Centers for Medicare and Medicaid Services has collected just little more than half of $498 million in Medicare overpayments identified in eight-year-old audits, according to Health and Human Services’ Office of the Inspector general.