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.

Humana to open clinics at 23 empty Walmart Health locations

The clinics will open in 2025 with a new focus on providing primary care to seniors under the CareWell and Conviva brands.

Northwell Health launches film studio backed by Creative Artists Agency

The newly founded Northwell Studios will work on documentary and scripted projects that creatively “humanize” the healthcare experience for patients and clinicians.

M&A mergers and acquisitions business deal

Molina Healthcare to buy Connecticut insurer for $350M

The cost represents “25% of expected 2024 premium revenue of $1.4 billion,” with Molina adding 140,000 members through plans in the state.

Industry Watcher’s Digest

Physicians shouldn’t think of AI as a tool to wield and sharpen. They should think of it as a medical student to mold and mentor.

AI represents the single biggest opportunity to fundamentally transform healthcare since antibiotics.

Brainstorm, collaborate to save healthcare AI from a ‘failure of imagination’

The suggestion comes from a strategic communications professional who specializes in thinking creatively about how to unlock opportunities—including those that are, at present, hard to see.

House lawmakers want to relax ban on physician-owned hospitals

The bipartisan Physician Led and Rural Access to Quality Care Act would amend the Social Security Act to allow physicians to open new hospitals in hard-to-reach communities.

Medicare Money dollar payment reimbursement

Humana buys stake in Healthpilot to expand Medicare Advantage portfolio

Healthpilot will remain an independent, payer-agnostic company despite Humana’s minority stake.

Nationwide IT outage leaves hospitals without EHRs

Many hospitals that use Epic were unable to access services, forcing them to operate on pen-and-paper and cancel non-emergency care delivery. The disruption was caused by an error with security vendor CrowdStrike.

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