CarelonRx, Elevance Health’s pharmacy benefits manager, is debuting an analytics tool that aims to make it easier for employers to plan for future specialty pharmacy costs while providing advocacy to employees who utilize specialty medications.
Category: Health Insurance
Providers, payers granted additional time to report HEDIS results due to Change cyberattack
NCQA has extended the deadline for HEDIS MY 2023 submission to 5 p.m., June 28, due to the Change Healthcare cyberattack.The extension represents an additional two weeks to report 2023 HEDIS results.
Walmart announces closing of clinics and virtual care
Walmart is closing Walmart Health and Walmart Health Virtual Care, saying the business model was not profitable nor sustainable.
The Walmart Health centers opened in 2019.
Sign Here? Financial Agreements May Leave Doctors in the Driver’s Seat
Agreeing to an out-of-network doctor’s own financial policy — which generally protects their ability to get paid and may be littered with confusing insurance and legal jargon — can create a binding contract that leaves a patient owing.
Telehealth boosts outcomes, spending, as regulatory flexibilities are in question
The rapid adoption of telehealth services, accelerated by the COVID-19 pandemic, has had a positive result on outcomes and resulted in a boost in healthcare spending, according to a report in Health Affairs.
The researchers investigated the relationshi…
HIMSSCast: The need for home care continues
A nurse by training, Tim Ashe, chief clinical officer at Wellsky, knows the challenges that burnout, staffing shortages and bed capacity have on clinicians and the health system.
One way hospitals dealt with staffing shortages and the need for beds dur…
Humana’s 2025 earnings, pricing decisions and membership may take hit from MA rate notice
Humana, one of the biggest players in the Medicare Advantage market, raised its 2024 individual Medicare Advantage annual membership growth by 50,000 to now anticipate annual growth of approximately 150,000, or 2.8%, the company said this week during i…
Kaiser reports 13.4 million people affected by data breach
Kaiser Foundation Health Plan has reported a data breach affecting over 13 million people.
Millions Were Booted From Medicaid. The Insurers That Run It Gained Medicaid Revenue Anyway.
Big health insurers that have contracts with state Medicaid programs find themselves making more money even as enrollment in Medicaid programs has dropped. Here’s why.
MGMA wants Change to take responsibility for HIPAA breach notifications
MGMA has sent a letter to the Department of Health and Human Services’ Office for Civil Rights seeking clarity on whether providers or Change Healthcare will be responsible for alerting affected patients that their personal health information may have …
