Managed Care

How Can Smart IT Fix Duplicate Medicaid Enrollments?
Management & Administration How Can Smart IT Fix Duplicate Medicaid Enrollments?

The challenge of duplicate enrollments in Medicaid and the Children’s Health Insurance Program (CHIP) has quietly siphoned off billions of taxpayer dollars for years, creating a financial burden that undermines the efficiency of these critical healthcare programs. This issue arises when

Why Is CareOregon Limiting Out-of-Network Mental Health Care?
Management & Administration Why Is CareOregon Limiting Out-of-Network Mental Health Care?

In a healthcare landscape increasingly defined by rising costs and funding uncertainties, a significant policy shift by CareOregon, a Portland, Oregon-based nonprofit managed care organization, has sparked attention and concern among its members and industry observers. This nonprofit, the largest

How Are Employers Tackling Rising Specialty Drug Costs?
Management & Administration How Are Employers Tackling Rising Specialty Drug Costs?

The escalating expense of specialty drugs, critical for treating complex conditions such as cancer and rare diseases, has emerged as a pressing issue for employers and health plans across the healthcare landscape, demanding urgent and innovative solutions. With these medications accounting for a

Can Centene Overcome Its Legal Challenges and Restore Trust?
Management & Administration Can Centene Overcome Its Legal Challenges and Restore Trust?

Centene Corporation, a leading player in government-sponsored healthcare programs, has found itself embroiled in a significant legal quagmire, with allegations of securities fraud and corporate misrepresentation taking center stage. This high-profile class-action lawsuit has instilled a sense of

UnitedHealth Faces DOJ Investigation Over Medicare Operations
Management & Administration UnitedHealth Faces DOJ Investigation Over Medicare Operations

The recent cooperation of UnitedHealth Group with an extensive U.S. Department of Justice (DOJ) investigation marks a significant development amidst rising concerns over corporate practices within the Medicare landscape. The investigation focuses on allegations that UnitedHealth manipulated

Integrated ACOs to Improve Care for Dual-Eligible Patients
Management & Administration Integrated ACOs to Improve Care for Dual-Eligible Patients

The dual-eligible population, comprising individuals eligible for both Medicare and Medicaid, represents one of the most vulnerable segments of the healthcare system, often facing gaps in service delivery. Current healthcare structures do not adequately address the complexities of their care needs.

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