All stories
Jump to date
Wednesday, August 26 · 3 stories
- Industry
Home-Based Care Referrals Shift to Performance Metrics Over Relationships
Health systems and payers are increasingly steering patients to home health and home care agencies based on documented performance metrics rather than traditional referral relationships, according to industry leaders speaking at a recent Home Health Care News webinar. The shift prioritizes agencies that can demonstrate quality ratings, low hospitalization rates, fast patient acceptance times, broad payer network coverage, and capacity to manage complex cases. This trend affects how Medicaid managed care organizations and health systems select post-acute care partners and may influence which home health providers maintain or lose patient volume. The change reflects broader value-based care adoption and risk-based contracting in home-based services.
Tuesday, August 25 · 3 stories
- Industry
Pediatric Drugs Lead FDA Active Shortage List with 18 Products
Pediatric medications account for more active FDA-listed drug shortages than any other therapeutic category as of August 25, 2026, with 18 products in shortage. Anesthesia and cardiovascular drugs are tied for second with 10 active shortages each, followed by analgesia and addiction treatment medications with 9 shortages. The data comes from the FDA's drug shortage database tracking current supply disruptions across therapeutic categories.
- Industry
Elevance Names Patrick Fox President of Carelon Behavioral Services
Elevance Health appointed Dr. Patrick Fox as president of Carelon Behavioral Services, effective immediately. Fox, a forensic psychiatrist with health plan leadership experience, will oversee the behavioral health division serving Elevance's Medicaid, Medicare, and commercial lines of business. The appointment reflects Elevance's continued investment in behavioral health capabilities amid growing Medicaid managed care focus on mental health and substance use disorder services. Fox replaces the previous leadership at one of the nation's largest behavioral health benefit managers serving Medicaid populations.
- Industry
GLP-1 Medications Show Potential to Treat Addiction, Emerging Research Suggests
Emerging research indicates that GLP-1 medications, widely used for obesity and diabetes treatment, may help treat addiction disorders. The studies add to a growing list of unanticipated effects associated with this drug class. The findings are preliminary and do not yet reflect approved indications or clinical practice guidelines. If further research confirms these effects and leads to FDA approval for addiction treatment, Medicaid programs could face coverage decisions for a new high-cost indication with significant budget implications.
Monday, August 24 · 2 stories
- Industry
Health Systems Alert Patients to MyChart Phishing Scam Impersonating Epic Portal
Health systems are warning patients about phishing attempts impersonating Epic's MyChart patient portal to steal personal information. Epic states the scam represents brand exploitation by cybercriminals rather than a security breach of its systems. The phishing attempts target patients using fake MyChart communications. This activity affects Medicaid managed care organizations and providers using Epic's widely-deployed patient portal system, potentially compromising protected health information and member data security.
- Industry · CA
Becerra Enters California Governor's Race Amid Rising Uninsured Rates Under Trump
Xavier Becerra, who served as U.S. Health and Human Services Secretary when the national uninsured rate reached historic lows, has announced his candidacy for California governor. His campaign comes as recent Trump administration actions have led to increases in the number of uninsured Americans, creating a political challenge for his candidacy. The timing puts healthcare coverage and access at the center of California's gubernatorial race. Becerra oversaw federal Medicaid policy and ACA implementation during his tenure as HHS Secretary.
Friday, August 21 · 5 stories
- Industry
Trump Nominates Overton to Lead FDA
President Trump has nominated Heidi Overton, MD, currently deputy director of the White House Domestic Policy Council and a veteran of the America First think tank, to serve as FDA Commissioner. The nomination requires Senate confirmation. If confirmed, Overton would oversee the agency responsible for drug approvals, safety monitoring, and regulatory oversight affecting Medicaid pharmacy benefits, including biosimilar approvals and drug supply chain policies. The nomination comes as states and managed care plans manage rising prescription drug costs.
- Industry · RI
Brown University Health Reports Break-Even as Uncompensated Care and Medicaid Pressures Mount
Brown University Health reported returning to break-even financial performance but warned of continued strain from uncompensated care costs, insurance denials, and federal Medicaid restrictions. CFO Peter Markell stated that break-even is insufficient for long-term sustainability. The system faces ongoing financial pressure from Medicaid reimbursement constraints and rising uncompensated care burdens. The announcement comes amid uncertainty about services at Newport Hospital's birthing center, though the health system declined to provide details.
- Industry
Humana Names Shantanu Nundy Chief Medical Officer
Humana has appointed Dr. Shantanu Nundy as its new chief medical officer. Nundy joins from Accolade, a health navigation company, and brings experience advising the FDA on artificial intelligence, academic medicine, international health work with the World Bank, and clinical practice. The appointment reflects Humana's leadership priorities as a major Medicaid and Medicare managed care organization. No effective date was specified in the announcement.
- Industry
Four Major Home Care Companies Deploy Technology to Address Workforce Shortages
Four publicly traded home care providers—Aveanna Healthcare, BrightSpring Health Services, The Pennant Group, and Addus HomeCare—emphasized technology investments as a staffing solution during recent earnings calls. The companies are deploying digital tools to improve caregiver recruitment, retention, and scheduling efficiency amid ongoing workforce challenges in home-based care. While Medicaid finances the majority of home care services nationally, these technology strategies focus on operational efficiency rather than reimbursement-driven initiatives. The developments reflect industry-wide efforts to sustain care delivery capacity in a tight labor market.
- Industry
Cityblock Acquires Rural Provider Homeward Health, Closes $116M Series E
Cityblock announced a definitive agreement to acquire Homeward Health, a rural-focused healthcare company offering virtual and in-home services, in an all-stock transaction. The acquisition coincides with Cityblock's closure of a $116 million Series E funding round. The deal was announced Thursday in a blog post by Cityblock CEO Toyin Ajayi. The transaction brings together Cityblock's urban-focused Medicaid managed care model with Homeward Health's rural care delivery infrastructure.
Thursday, August 20 · 2 stories
- Industry
Epic Launches AI Outpatient Visit Tool with Ochsner as First User
Epic Systems has released a new artificial intelligence tool designed to enhance outpatient office visits by extracting insights from patient records. Ochsner Health in Louisiana became the first health system to implement the tool. The technology aims to streamline clinical workflows by leveraging AI to analyze patient data during outpatient encounters. The development reflects Epic's broader strategy to integrate AI capabilities into its electronic health record platform.
- Industry
R1 RCM Acquires Humata to Automate Prior Authorization Processing
R1 RCM acquired Humata, an AI-powered prior authorization platform, to automate claims processing and medical preapprovals. The acquisition aims to streamline revenue cycle operations by reducing administrative burden in the prior authorization process. The deal closed in August 2026, with integration timelines not yet disclosed. For Medicaid managed care plans and providers, this signals continued consolidation in the revenue cycle management sector and potential shifts in how AI tools are deployed for authorization workflows.
Wednesday, August 19 · 10 stories
- Industry
Trump Nominates White House Health Adviser Heidi Overton as FDA Commissioner
President Trump announced Wednesday he will nominate Dr. Heidi Overton, currently a White House domestic policy adviser on health issues, to serve as FDA Commissioner. The nomination comes amid significant staff turnover at the agency. If confirmed by the Senate, Overton would lead the FDA's oversight of prescription drugs, including Medicaid drug coverage policy and pharmaceutical manufacturer rebates. The nomination's impact on Medicaid will depend on Senate confirmation timing and Overton's policy priorities once in office.
- Industry
CareCloud Reports Data Breach Affecting 3.8 Million Patients
Health IT vendor CareCloud disclosed a data breach impacting 3,756,469 individuals following a March 16, 2026 network disruption in its CareCloud Health division. The incident temporarily disrupted access to one of six electronic health record environments for approximately eight hours. A subsequent forensic investigation confirmed unauthorized access occurred. The breach affects patients whose data was stored in CareCloud's EHR system, which serves healthcare providers including those participating in Medicaid programs.
- Industry
UHS Closes $835 Million Talkspace Acquisition for Virtual Therapy
Universal Health Services completed its $835 million acquisition of Talkspace, a virtual therapy provider, on Monday. UHS CEO Marc Miller described the deal as a strategic bet on virtual behavioral health delivery. The acquisition closed in August 2026 and positions UHS to expand its behavioral health capabilities through digital channels. The deal matters for Medicaid stakeholders because many states now cover telehealth behavioral health services through managed care contracts, and UHS operates facilities serving significant Medicaid populations.
- Industry
PBMs Agree to Display TrumpRx Cash Prices in Real-Time Benefit Tools
The Pharmaceutical Care Management Association announced that its members will share TrumpRx's cash drug prices through real-time benefit tools and cost transparency platforms. The commitment follows coordination with the Trump administration and CMS Administrator Mehmet Oz. PCMA members include CarelonRx, CVS Health, and Cigna. The announcement was made in an August 13 news release.
- Industry
Bankruptcy Attorney Discusses Medicaid Cuts and Hospital Closures on Restructuring Podcast
A Sheppard Mullin podcast episode features Dentons partner Samuel Maizel discussing healthcare bankruptcies, including Medicare and Medicaid provider agreement disputes and hospital and skilled nursing facility closures. The discussion covers how healthcare Chapter 11 cases differ from other bankruptcies due to provider agreements and regulatory constraints. The episode addresses financial pressures including Medicaid cuts and private equity involvement in distressed healthcare assets. No specific policy changes or case details are provided.
- Industry
Providence Health Plan to Exit All Lines of Business After Medicare Advantage Sale Collapses
Providence Health Plan will shut down operations entirely after a proposed sale of its Medicare Advantage business to an unnamed national insurer fell through. The regional health plan had been pursuing the transaction to sustain its MA lines, but the deal collapsed "despite significant effort on all sides," according to a Providence spokesperson. The closure will affect all plan lines, not just Medicare Advantage. The timeline for wind-down and member transitions was not disclosed in available reporting.
- Industry
VNS Health Virtual Caregiver Coaching Program Cuts Hospitalizations for Heart Failure Patients
VNS Health's Center for Home Care Policy & Research reports that its virtual caregiver coaching program for informal caregivers of heart failure patients reduced hospitalizations and improved quality of life. The program helps caregivers manage stress and improve self-care for the patients they support. The initiative demonstrates potential cost savings through reduced acute care utilization. The finding is relevant for Medicaid programs that cover substantial home and community-based services and long-term care populations where caregiver support affects institutional utilization.