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Strategic Planning / Payer
Patrick Conway to take over CEO duties at Optum Health
Susan Morse
June 27, 2025
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Reimbursement / Payer
Physician group, cities sue CMS over ACA final rule
Rule will cause at least 1.8M Americans to lose ACA coverage and result in higher premiums and out-of-pocket costs, lawsuit says.
Susan Morse
July 08, 2025
Operations / Payer
St. Luke's saves $13,000 per clinician through ambient AI pre-chart summary
Eighteen months of patient history is summarized in two to three bullet points.
Susan Morse
July 08, 2025
Quality and Safety / Payer
Provider groups sue RFK Jr. over COVID-19 directive
Susan Morse
July 08, 2025
Medicaid, ACA enrollment expected to decrease under One Big Beautiful Bill Act
Payment decrease could be a 'death knell' for UnitedHealth, Amedisys deal
Senate removes PBM provision from tax and spending bill
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Strategic Planning / Payer
UnitedHealth launches tech-enabled personalized provider search
Susan Morse
June 20, 2025
Policy and Legislation / Payer
Senate removes PBM provision from tax and spending bill
Susan Morse
July 03, 2025
Workforce / Payer
Sharp HealthCare reduces workforce by 1.5%, citing economy
Jeff Lagasse
July 03, 2025
Quality and Safety / Payer
Optum Rx scraps reauthorization requirements for more than 60 drugs
Jeff Lagasse
July 03, 2025
Population Health / Payer
Senate boosts rural hospital fund to offset Medicaid cuts
Susan Morse
July 02, 2025
Operations / Payer
324 charged in connection with $14.6 billion in healthcare fraud
Defendants include 96 doctors, nurse practitioners, pharmacists and other licensed medical professionals.
Jeff Lagasse
July 02, 2025
CMS notifies patients impacted by data breach
CMS launches prior authorization pilot for Original Medicare
KEY PAYER TOPICS
MEDICARE & MEDICAID / Payer
324 charged in connection with $14.6 billion in healthcare fraud
Defendants include 96 doctors, nurse practitioners, pharmacists and other licensed medical professionals.
Jeff Lagasse
July 02, 2025
CMS notifies patients impacted by data breach
CMS launches prior authorization pilot for Original Medicare
6.4% payment decrease proposed for home health agencies
Michigan doctor sentenced in $6.3 million Medicare fraud scheme
ANALYTICS / Payer
Patient engagement needs data intelligence
HIMSS TV
July 01, 2025
Building superintelligence using AI
Sparta Community Hospital improves SDOH data capture
EHR data should be actionable for providers
BayCare settles with HHS over alleged HIPAA violations
REVENUE CYCLE MANAGEMENT / Payer
Cedar announces agentic AI for healthcare billing
Revenue cycle teams are able to resolve billing inquiries faster through an automated AI call center.
Susan Morse
April 30, 2025
Cleveland Clinic to debut AI tools for revenue cycle
Behavioral health should shift to value-based care despite challenges, Evernorth says
Forecasting what's ahead for healthcare in 2025
Athenahealth leverages AI to power RCM offering