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Margin improvement, MA member retention doable, as is top quartile star rating results in 2028, company says.
The approach will be used for medical services that are commonly subject to prior authorization, such as orthopedic surgeries and imaging services.
Kurt Small, president of Medicaid for Elevance, will become president and CEO of CareFirst BlueCross BlueShield.
CVS Health, Highmark, Waystar and others partner with Google Cloud for agentic AI solutions.
Jeremy Gaskill is the new president of Geisinger Health Plan and executive vice president of insurance operations for Geisinger.
MA enrollment increases of 1%-3% over the last two years compare with 7%-10% between 2017 and 2024.
Humana purchased Florida-based MaxHealth from private equity firm Arsenal Capital Partners for an undisclosed sum.
Revenue growth will come from clinical outcomes versus document mechanics, says Steve Mongelli, president at mPulse.
Executives cite rising medical costs due to increased utilization and an MA payment rate that came in below the medical cost trend.
The AI assistant offers personalized answers to members’ health benefit questions.
