For 2025, Humana anticipates adjusted profit to align with or exceed its final 2024 results. Revenue was up $29.4B year-over-year (YOY) but net income and the insurer's profit margin fell 42% and 1.6%, respectively. Analysts project a 2025 profit...
In this week's election, Arizona voters were asked if they wanted abortion to be legal up to the point of fetal viability (23-24 weeks) and they overwhelmingly (62%) said "yes."
Women in Arizona can now expect to access the same level of reproductive healthcare available since the 1973 Roe v Wade decision, which found a women's right...
Negotiations between the local, popular insurer and one of the nation's premier pediatric health systems failed to produce a new agreement by midnight last night and now Phoenix Children's 50 sites in Arizona, including two hospitals, Phoenix Children's Pediatrics, Phoenix Children's Medical Group, four urgent care centers, specialty...
The Medicare Shared Savings Program (MSSP) is one of the country's largest value-based payment programs, serving nearly 11 million Medicare beneficiaries. In 2023, the program saved Medicare $2.1B, the largest savings in the program's history. In Arizona, 17 MSSP Accountable Care Organizations (ACOs), some which serve several states...
The Medicaid and CHIP Payment Access Commission (MACPAC) published an issue brief on the updated regulations for oversight of Medicaid managed care and state allowances for the direction of managed care organizations (MCOs).
Earlier this year, the Centers for Medicare and Medicaid Services (CMS) issued a rule for the directed payment...Arizona News
On October 25, U.S. Bankruptcy Court Judge Christopher Lopez approved the sale of seven more Steward hospitals to Nevada-based Healthcare Systems of America, an affiliate of Glendale, Calif.-based American Healthcare Systems. Days earlier, Lopez approved College Medical Center Phoenix as the interim manager of the recently closed 127-bed...National News
The American Medical Association (AMA) has filed suit in the Northern District of Illinois against data analytics company/claims discounter/wrap network, Multiplan for what it claims is a price-fixing conspiracy on behalf of health insurers.
The lawsuit claims that MultiPlan benefits from lowering estimates of out-of-pocket...Arizona News
Insurance company Centene defied the odds for the third quarter and overcame issues with Medicaid reimbursement for higher returns than investors had anticipated.
Centene reported $713 million in profit for Q3 on $42 billion in revenue, up from $469 million and $38 billion last year. Following the Medicaid redetermination period, more...Arizona News
Vice President Kamala Harris and former President Donald Trump delivered their final pitches to the American public this week ahead of election day on November 5. Both candidates refined their positions on healthcare policy and the people they'd entrust with health matters should they win the White House.
Throughout the campaign...National News
Medicare Advantage companies are banking billions in extra payments from the Medicare program with health risk assessments, according to new investigations and reports.
The health risk assessments (HRAs), in which physicians employed by insurers do home visits with MA members that then adjust Medicare reimbursement rates per member,...Arizona News
Open Enrollment Period (OEP) on HealthCare.gov runs from November 1 to January 15. Consumers who select a plan by midnight December 15 (5 a.m. EST on December 16) can get full-year coverage that starts January 1, 2025. Consumers who select a plan after December 15, 2024, but before the deadline in January 2025, can have coverage that...
Researchers found the average Medicaid payment covered about 82% of reported costs, meaning nursing homes typically received 82 cents for each dollar spent on Medicaid residents' care.
Using Medicaid payment data from individual states and Medicare cost reports for freestanding nursing homes in 44 states, ASPE researchers...
Humana's rough patch continues as it sues the U.S. Department of Health and Human Services over star ratings and revisits a potential merger with Cigna.
This month, Humana reached a $90 million settlement with the United States over allegations of fraudulent bids submitted to the Centers for Medicare and Medicaid Services (CMS) for...Arizona News
This week, trade associations ask regulators to reform requirements for participation in value-based care initiatives and improving alternative payment models to drive adoption of value-based care.
The American Medical Association, the Association of Medical Colleges, the Medical Group Management Association, and the National...National News
Medigap, the Medicare supplement insurance that helps cover Part A and Part B cost-sharing, may be due for some reforming in the near future as several aspects of the program are causing issues that lower regulatory infrastructure can't fix on their own.
As medical debt is a major concern for one in five older adults, the Medicare...
Advances in artificial intelligence (AI) and other tech innovations continue to find applications throughout the medical industry, including in Arizona.
As more AI applications enter the biomedical industry, the Food and Drug Administration has investigated how it should go about regulating the programs, platforms and devices that use...
On Monday, the Biden administration announced a new proposed rule by the U.S. Department of Health and Human Services (HHS) together with the Labor Department (DOL) and the U.S. Department of Treasury, that would expand access to contraceptive products by making them free to all women of reproductive age with private health...
On Thursday, the Senate Homeland Security Permanent Subcommittee on Investigations (PSI) published a report on Medicare Advantage denials for post-acute care services. The study showed that the three largest Medicare Advantage insurers, UnitedHealthcare, Humana and CVS Aetna, significantly raised the rate of prior authorization denials...
Reports have shown Arizona is falling far behind the pack on adult mental healthcare and ranks among the lowest in the country because of its prevalence of mental illness and limited access to mental healthcare. According to CMS data, the nation's highest psychiatric readmission rate was 35% in contrast to a 13.4% readmission rate at...Open
After submitting intent to not renew its contract with the local insurer, Wickenburg Community Hospital has agreed to rates proposed by Blue Cross Blue Shield of Arizona (BCBSAZ). The 19-bed community-owned Critical Access Hospital and health system, along with its three rural health clinics in Wickenburg, Congress, and Wittmann,...Arizona News
The only children’s hospital in Arizona ever recognized by U.S. News & World Report rated the pediatric health system the No. 1 children’s hospital in Arizona again this year and third in the Southwest region. Earlier this month, Phoenix Children's appointed four new division chiefs in pathology and laboratory medicine,...National News
More than 67 million Americans are Medicare-eligible. This month, as Medicare Advantage (MA) plans promote low co-pays and extra benefits to potential enrollees, plan sponsors are pushing back against CMS's cuts to star rating bonuses. Meanwhile, a former CMS official advises stricter regulation of MA plans as they continue to woo...Arizona News
Medicaid and Children’s Health Insurance Program (CHIP) will now cover traditional healthcare practices provided by Indian Health Service (IHS) facilities, Tribal facilities, and urban Indian organizations in Arizona, California, New Mexico and Oregon after approving the four states' section 1115 demonstration waivers. Since 2015 the...
Election day is drawing near and the candidates for president are distinguishing themselves with healthcare policy proposals.
Vice President Kamala Harris's campaign released several health-related potential policies over the past several weeks, including a plan to boost long-term care at home. According to Axios, up to a third of...
Arizona hospitals are facing a shortage of intravenous (IV) fluid bags due to a national disruption in the supply caused by Hurricane Helene.
Banner Health is delaying certain elective surgeries, has received some partial shipments of IV bags and implemented other "conservation measures" after the hurricane damaged a Baxter...
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