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Strategist | Strategy CatalystFTC to sue major PBMs over drug rebate tactics

The FTC is preparing a lawsuit against the three largest PBMs—OptumRx, Express Scripts, and CVS Caremark—over allegations that they steered patients to more expensive drugs in exchange for manufacturer rebates.

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Strategist | Strategy CatalystPayers flag rise in Medicaid utilization

Stock prices for UnitedHealth Group and Centene fell by 5% following reports that the payers are experiencing a mismatch between Medicaid enrollees’ care utilization and the rates that states pay.

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Strategist | Strategy CatalystCMS will recalculate MA star ratings after legal losses

CMS confirmed it will rework this year’s Medicare Advantage star ratings after facing a string of legal losses in cases brought by payers disputing recent methodological changes.

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Strategist | Strategy CatalystBipartisan bill looks to codify time limits on prior authorization in MA

A bipartisan bill to reform prior authorization in Medicare Advantage has been introduced in Congress with 130 representatives and 42 senators as sponsors, a signal of broad support.

Academy 360 | All-AccessOptimizing Revenue Cycle Efficiency Through Denials Management

Faced with the dual challenge of tighter margins and rising costs, Leading Health Systems are under intense pressure to optimize their revenue cycle management. A key component is denials management.

Article | All-AccessWelcoming the Class of 2025 Academy GE Finance Fellows

Introducing the Class of 2025 Finance Fellows, including 14 financial executives from Leading Health Systems across the country.

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Strategist | Strategy CatalystPWC projects rising costs for commercial insurers

The accounting firm PwC released a report estimating that commercial healthcare costs will grow by 8% next year, setting the stage for tougher contract negotiations.

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Video | Strategy CatalystEmerging Margin Pools: Who is Making Margin Today?

Insight on safe margin pools and the shifting LHS landscape.

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Video | Executive Insight HubHow Industry Can Align Their Pitch to Health System Value-Based Care Goals

Voice of the customer perspective on leading health system population health strategy

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Video | Strategy CatalystEmerging Margin Pools: Who is Making Margin Today? (1)

Insight on safe margin pools and the shifting LHS landscape.

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Strategist | Strategy CatalystHumana’s CenterWell opening 23 clinics at Walmart locations

Humana announced plans to lease clinical space and open 23 senior-focused primary care clinics at Walmart stores in the first half of 2025. Financial terms were not disclosed.

Academy 360 | Academy 360Pulse Check: How Are Health Systems Thinking About Investing in Clinical Innovations Today?

By nature, health systems are compelled to pursue adoption of clinical innovations to improve care delivery and health outcomes.

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Video | Strategy CatalystEmerging Revenue Diversification Opportunities: How are LHS tapping into margin pools and what’s been successful?

Insight on safe margin pools and the shifting LHS landscape.

Video | Strategy CatalystMarket Update: Primary Care and Payvider Disruption

An update on primary care and the payvider landscape and what it means for LHS strategists.

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Video | Strategy CatalystMedicare Advantage: How is the Market Changing and How Should You Respond?

Insight on Medicare Advantage (MA) and MA payers

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Video | Strategy CatalystSpotlight on “Payviders”

Insight on payers and the Optum playbook.

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Strategist | Strategy CatalystCVS is seeking a PE investor for Oak Street

According to a report by Bloomberg, CVS is searching for a private equity partner to help fund the expansion of Oak Street Health.

Dec 22, 2022

Podcast | All-AccessAssessing the Health Policy and Investment Landscape