Business Intelligence

Providers utilize business intelligence to monitor referral patterns and collaborate with clinicians who order their services. Such analytics tools have also been deployed in the specialty to improve productivity, track patient satisfaction and bolster quality.

Florida probes CVS Health in latest crackdown on PBMs
State Attorney General James Uthmeier is forcing the company to hand over thousands of documents related to its pharmacy contracts and reimbursement policies to see if the retail giant is abusing its position in the market as both a pharmacy benefit manager and a retail chain of drug stores.
Private equity unlikely to dominate cardiology despite hype
Medaxiom CEO Jerry Blackwell, MD, MBA, FACC, discusses investor's interest in buying cardiology practices, noting that PE ownership remains relatively low.
OIG warns of ‘ghost network’ trouble in maternal health managed care
Looking at the three largest Medicaid managed care plans related to maternal health, the Office of Inspector General found instances of ineligible providers being included in directories, as well as other errors such as incorrect contact information.
OhioHealth agrees to void contracts that allegedly punished payers for including competitors in-network
The U.S. Department of Justice said the settlement will save citizens of the state money and open up the market to competition.
Major private payer encouraging employees to leave willingly
The largest Medicaid-specialized managed care organization in the U.S. is offering buyout packages to most of its 60,000 or so staff workers.

Industry Watcher’s Digest

The use of clinical AI could have some unintended consequences for patient safety.

healthcare providers and payers AI strategy

Providers trail payers in healthcare AI action

If putting an AI plan in place were a team sport, the Payers would be outpacing the Providers quite handily.

Landmark opioid trial in Baltimore set to begin; Johnson & Johnson settles to avoid jury

Six companies have settled with the city for as total of over $402M. Two remaining defendants, McKesson and AmerisourceBergen, will test their luck in court.

Walgreens pays $107M to resolve fraud accusations brought by DOJ

The company was accused of billing the government for prescriptions patients never received. Walgreens said the oversight was a result of a software error.

FDA issues recall on infusion pump parts due to risk of uncontrollable drug flow

Due to a risk of fatal overdose, the recall is labeled as the most serious of its type. While no patients have died, two have reportedly been injured.

Social media ads led 200K patients to unwittingly drop their insurance

Users on Facebook and Snapchat clicked on ads promising free cash, only to find out their health plan changed.

AMA study shows four pharmacy benefit managers control 70% of the market

The study from the American Medical Association is based on data from commercial and Medicare Part D plans. The analysis found market share for PBMs is heavily concentrated, leading to higher drug costs.

artificial intelligence AI in healthcare

Industry Watcher’s Digest

CIOs are commanding bigger paychecks than ever before.

Business Intelligence

Florida probes CVS Health in latest crackdown on PBMs

Private equity unlikely to dominate cardiology despite hype

OIG warns of ‘ghost network’ trouble in maternal health managed care

OhioHealth agrees to void contracts that allegedly punished payers for including competitors in-network

Major private payer encouraging employees to leave willingly