Latest news with #HealthcareDive
Yahoo
9 hours ago
- Business
- Yahoo
Epic charts growth in provider TEFCA adoption
This story was originally published on Healthcare Dive. To receive daily news and insights, subscribe to our free daily Healthcare Dive newsletter. More than 1,000 hospitals and 22,000 clinics that use Epic are live on the federal government's health information sharing framework, the electronic health record vendor said Monday. Epic plans to transition all of its customers to the Trusted Exchange Framework and Common Agreement, or TEFCA, by the end of the year, according to Matt Doyle, Epic's Interoperability Software Development Lead. Currently 41% of Epic's customers are live with TEFCA, while 43% are working to implement the data sharing network. The remaining 16% are in planning stages, Doyle said in an emailed statement. TEFCA is a major initiative for healthcare interoperability, setting technical requirements and exchange policies for companies to pull together clinical information sharing networks across the country. The framework went live in December 2023 with five Qualified Health Information Networks, organizations that represent health systems, insurers or health IT vendors that can query and receive information from other networks. Epic's network, Epic Nexus, was one of the original QHINs designated at TEFCA's launch. The government framework lowers barriers to health data sharing, allowing more providers in rural and underserved communities to easily exchange information and improve care, Epic said Monday. The company had previously said last year it would move all of its customers onto TEFCA by the end of 2025. The number of QHINs has also expanded since TEFCA went live. This spring, e-prescribing giant Surescripts' data exchange said it had received QHIN status, bringing the number of designated information sharing networks to nine. Oracle Health, an EHR competitor with Epic, is also looking to earn QHIN designation. The technology giant submitted its application in February. Epic is a major player in healthcare technology as the nation's largest EHR vendor. The vendor controlled more than 42% of the acute care hospital market last year, according to a report published this spring by healthcare IT research firm Klas Research. Recommended Reading Surescripts receives QHIN status under TEFCA Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Yahoo
5 days ago
- Business
- Yahoo
Athenahealth names CVS alum as CFO
This story was originally published on Healthcare Dive. To receive daily news and insights, subscribe to our free daily Healthcare Dive newsletter. Name: Tom Cowhey Previous title: Executive vice president and CFO, CVS Health New title: CFO, Athenahealth Cowhey will take on the finance chief position on June 9, the health IT firm and electronic health record vendor said Tuesday. He replaces John Hofmann, Athenahealth's previous CFO who joined in 2022. Hofmann stepped down late last year, and the health IT company has operated with an interim finance chief while it conducted a search for his successor, a spokesperson told Healthcare Dive. Cowhey joins Athenahealth from healthcare behemoth CVS, where he served as permanent CFO since early last year. In April, CVS named a new finance head, Brian Newman, who took on the role later that month. Cowhey also previously worked as CFO at ambulatory surgical care firm Surgery Partners and held leadership roles at insurer Aetna before it was acquired by CVS. Cowhey's departure from CVS followed a spate of leadership changes at the healthcare giant while the company managed a challenging financial environment. The firm's profits were cut nearly in half last year as its insurance arm Aetna battled high medical costs that dinged its bottom line. However, CVS gained momentum in the first quarter, reporting a 60% increase in net profit year over year and beating investor expectations on earnings and revenue. CVS also said it would stop offering health plans on the Affordable Care Act exchanges next year, in an effort to focus attention on other business lines. Recommended Reading CVS taps former UPS finance chief as new CFO
Yahoo
23-05-2025
- Business
- Yahoo
CVS names new president of Oak Street Health
This story was originally published on Healthcare Dive. To receive daily news and insights, subscribe to our free daily Healthcare Dive newsletter. Name: Creagh Milford Previous title: President of Retail Health, CVS New title: President of Oak Street Health, a CVS subsidiary Milford is taking the reins at Oak Street Health effective immediately, according to a LinkedIn post from the executive. He's replacing Brian Clem, who has served as Oak Street president since 2019 and remained in the role through the company's acquisition by CVS. Clem is stepping down to spend more time with his family, according to a CVS spokesperson. CVS bought Oak Street, a multi-state chain of doctor-staffed medical clinics for seniors, in 2023 for $10.6 billion as the healthcare giant looked to expand its healthcare delivery capabilities. Since then, CVS has invested heavily in Oak Street and worked to integrate the business with its other divisions, including by nudging members of its Aetna health insurance products into Oak Street sites for care. Though CVS does not disclose whether the division is profitable, Oak Street has seen notable membership growth, with total at-risk members increasing by more than one-third year over year in the first quarter, according to executives. However, Oak Street is facing similar challenges as other value-based businesses, especially given that Oak Street specializes in contracting with Medicare plans to manage healthcare for their patients. Seniors, especially those in privatized Medicare Advantage plans, are using more medical care, and reimbursement shelled out by the federal government has yet to catch up. If the disconnect continues, that could lower CVS' operating income for 2025. 'While very immature, we have seen some signs of pressure in first quarter medical cost trends at Oak Street Health, which we will continue to monitor closely over the next several months as they continue to develop,' CVS CFO Tom Cowhey told investors on an earnings call earlier this month. Milford, who was trained as an internal medicine physician, first joined CVS in 2021 to oversee the company's virtual care portfolio before working his way up the ranks to president of retail health. In that role, the executive managed a number of CVS' healthcare delivery plays, including its MinuteClinic facilities and mental health and virtual care assets, according to Milford's LinkedIn. Milford is staying on as interim president of retail health for the near future, he said on the social media platform. Both Oak Street and CVS' retail health arm are under the company's healthcare delivery business, which is led by Sreekanth Chaguturu after its previous leader, Oak Street co-founder Mike Pykosz, left in November. Recommended Reading Oak Street Health co-founder departs CVS Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Yahoo
23-05-2025
- Business
- Yahoo
CMS expands audits to crack down on Medicare Advantage overpayments
This story was originally published on Healthcare Dive. To receive daily news and insights, subscribe to our free daily Healthcare Dive newsletter. The CMS will crack down on overpayments to Medicare Advantage plans, moving to significantly expand its capacity to audit whether insurers are inflating their enrollees' illnesses, the agency said Wednesday. Beginning immediately, the CMS will review all eligible MA contracts each payment year in newly initiated audits. The agency will also invest more resources to speed audits from payment years 2018 to 2024, planning to complete these older reviews by early 2026. To tackle a backlog of reviews from earlier payment years, the agency plans to use 'enhanced technology' to quickly review medical records and significantly increase its workforce of medical coders, the CMS said in a press release. The MA program, where private insurers contract with the federal government to manage beneficiaries' care, has become increasingly popular among seniors, now enrolling more than half of the eligible Medicare population. However, MA has been dogged by accusations from researchers and lawmakers that the program is increasing costs for the federal government by exaggerating the sickness of its members for increased reimbursement. MA plans are paid a fixed amount each month per member, adjusted for enrollees' health risks. Beneficiaries in the privatized plans tend to rack up more diagnosis codes than those in traditional Medicare, driving up their health risks and thus payments to insurers, according to a report by congressional advisory MedPAC published in March. Medicare will spend $84 billion more on MA enrollees this year than it would if those beneficiaries were in the traditional fee-for-service program, mostly due to favorable selection of healthier beneficiaries and coding intensity, according to the MedPAC report. The CMS conducts Risk Adjustment Data Validation audits to ensure that diagnoses used for payment are supported by medical records. But the agency said Wednesday it's several years behind in completing these reviews, noting the last significant recovery of MA overpayments took place following an audit of payment year 2007. To manage the backlog, the CMS said it will deploy 'advanced systems' to efficiently review medical records and flag potentially inflated diagnoses, according to a press release. Using technology will help the agency increase the number of audits from around 60 MA plans per year to about 550 plans, the CMS said. The agency also expected it can increase the records reviewed per plan each year from 35 to up to 200 records, based on the size of the health plan, according to the press release. The agency didn't respond to a request for comment by press time on what kind of technology it will use. Additionally, the CMS said it will increase its team of medical coders, who will manually verify flagged diagnoses, from 40 to about 2,000 by Sept. 1. The agency will also work with the HHS' Office of Inspector General to recover overpayments identified in past audits. 'We are committed to crushing fraud, waste and abuse across all federal healthcare programs,' CMS Administrator Dr. Mehmet Oz said in a statement. 'While the Administration values the work that Medicare Advantage plans do, it is time CMS faithfully executes its duty to audit these plans and ensure they are billing the government accurately for the coverage they provide to Medicare patients.' The Better Medicare Alliance, a lobbying group for the MA industry, said the move is the 'right approach' to ensure payment accuracy in the program. 'Medicare Advantage already includes strong accountability mechanisms and consistently enforcing them will help the program work even better for seniors and taxpayers alike,' Mary Beth Donahue, BMA's president and CEO, said in a statement. 'We look forward to working with CMS to ensure the methodology is accurate and appropriate.' Though its 'difficult to size' the potential challenges for insurers from the expanded audit plans, it could be an 'incremental headwind' for managed care organizations, especially insurers like Humana, CVS and UnitedHealth, J.P. Morgan analysts wrote in a Wednesday note. Oz, who was sworn in as head of the CMS last month, pledged to scrutinize MA insurers during his confirmation hearing earlier this year. Democrats had raised concerns about Oz's previous advocacy for the privatized Medicare plans, as well as his financial ties to major MA insurer UnitedHealth. His plans to expand the CMS' medical coding workforce also follows large-scale layoffs at the HHS. This spring, the department said it would reorganize and lay off 10,000 full-time employees, including cutting around 300 jobs at the CMS. Recommended Reading Dr. Oz vows to scrutinize Medicare Advantage as CMS head
Yahoo
20-05-2025
- Business
- Yahoo
UnitedHealth downgraded by investment banks
This story was originally published on Healthcare Dive. To receive daily news and insights, subscribe to our free daily Healthcare Dive newsletter. UnitedHealth, once the darling of Wall Street, is being downgraded by investment banks after the company pulled its profit guidance for 2025, abruptly swapped out its CEO and reportedly faces a criminal investigation by the Justice Department. Together, the challenges have tanked UnitedHealth's stock to pre-pandemic lows in just one month. Last week, Raymond James and Bank of America both downgraded UnitedHealth's stock, from 'strong buy' to 'market perform' and 'buy' to 'neutral,' respectively. And on Monday, TD Cowen downgraded UnitedHealth from 'buy' to 'hold.' Investors' points of concern include higher utilization in Medicare Advantage plans spreading to more complex patients, like people dually eligible for Medicare and Medicaid. In addition, changes to risk coding put in place by the Biden administration appear to be hampering UnitedHealth's ability to upcode, or account for more members' sicknesses in return for higher reimbursement from the federal government. UnitedHealth's insurance arm UnitedHealthcare is the largest provider of the privatized Medicare plans and upcodes at higher rates than its peers in the MA program, according to research. 'We suspect the v28 risk model is disproportionately impacting [UnitedHealth],' wrote TD Cowen analyst Ryan Langston in his note downgrading the company's stock. 'Accelerating MA care activity with potential acceleration in Commercial/Medicaid further complicates the story.' UnitedHealth's stock has also been pressured by a report the Wall Street Journal published Thursday finding that the Department of Justice is investigating UnitedHealth for possible criminal Medicare fraud, an allegation UnitedHealth denies. At the close of last week, UnitedHealth was trading at its lowest level since the summer of 2020, with five years of stock gains erased in about a month. Between mid-April and mid-May, UnitedHealth lost roughly $266 billion in market capitalization — half of its overall value — leading analysts to reverse their bullish outlook on the company's future prospects, especially given that the challenges facing UnitedHealth don't appear to be touching other insurers. $UNH price at close, Jan. 2025 to date This embedded content is not available in your region. Amid the turbulence, UnitedHealth CEO Andrew Witty stepped down last week citing personal issues. 'As of now, we view [UnitedHealth's] issues as company specific, and we think the quick resignation of the CEO indicates this is more likely to be internal than external,' Bank of America research analyst Joanna Gajuk wrote in her note downgrading the company. However, UnitedHealth's stock has experienced recent uptick after a number of company insiders, including UnitedHealth's new CEO, purchased millions of dollars in stock. Stephen Hemsley, UnitedHealth's board chair who replaced Witty as the company's chief executive, purchased $25 million in stock on Friday, according to a securities filing. CFO John Rex also bought about $5 million in stock, while three company directors — John Noseworthy, Kristen Gil and Timothy Flynn — also purchased shares. Despite UnitedHealth's troubles, many investors believe Hemsley is a good pick to usher the company back to profitable growth. The executive served as CEO from 2006 to 2017 and built UnitedHealth into the diversified healthcare giant it is today, containing a major health insurer, pharmacy benefit manager, physician network and health tech company. During Hemsley's tenure, UnitedHealth consistently outperformed earnings expectations — perhaps the reason UnitedHealth has approved a $61 million pay package for the new CEO. Recommended Reading Andrew Witty steps down as UnitedHealth CEO Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
