Optum Layoffs Affect Teams in Medicare Advantage I-SNP, IE-SNP Business

Optum is paring back its workforce, including in the parts of the business related to Medicare Advantage plans for nursing home and assisted living residents. This is according to multiple industry sources who communicated with Skilled Nursing News, as well as anonymous posts on an online message board related to the layoffs at Optum, which […]

Inside Rising Cyber Attacks: Tackling Insurance Hikes, Payment Disruptions at Nursing Homes

Health care cyber attacks have been an ever-present threat for providers, including nursing homes. But the most recent attacks on Change Healthcare have had ripple effects on the industry, prompting lobbying groups and federal agencies to action. The attack in February has affected cash flow and claims processes for some nursing home operators, associations said, […]

Humana Is Latest To Face Lawsuit for AI-Based Denials of Medicare Advantage Claims in Nursing Homes

In facing a class-action lawsuit for its use of artificial intelligence in denying claims for services to residents in post-acute care, Humana (NYSE: HUM) joins the ranks of other health insurance behemoths such United Healthcare and Cigna. The complaint, filed late Tuesday, in a federal court in Kentucky, accuses Humana of using AI tools – […]

Optum to Acquire Amedisys, Parent Company of SNF-at-Home Provider Contessa Health

Optum, the diversified care delivery arm of UnitedHealth Group (NYSE: UNH), has reached an agreement to acquire home health giant Amedisys (Nasdaq: AMED), which provides skilled nursing facility-at-home services via Contessa Health. Optum emerged as a suitor for Amedisys earlier this month, after the home health giant had previously announced a deal to combine with […]

AHCA’s CEO: Nursing Homes Must Prepare for ‘Massive’ Staffing Mandate Battle, Adapt to Managed Care ‘Mega-Trend’

Nursing homes are past the “nightmare” caused by Covid-19, but now are facing “a real business problem” that could be considerably worsened by the coming federal staffing mandate. That’s according to Mark Parkinson, CEO and president of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL). He spoke Tuesday of the urgent need to […]

AI Use by Medicare Advantage Blamed for Increased Denial of Nursing Home Services

Over-reliance on artificial intelligence is compromising post-acute care for nursing home residents on Medicare Advantage plans. This view of the problematic use of algorithms for prior authorizations – and denial based on incorrect assessment of patient needs – is at the center of reporting and analysis published in the health, medicine and life sciences publication, […]

Post-Acute, Senior Care Providers Must ‘Be the Answer’ for More Integrated Continuum

Skilled nursing and post-acute companies — and other providers serving older adults — must raise their games to deliver services within a new health care paradigm, as payers and consumers alike demand a more integrated continuum. In particular, post-acute and senior care companies must “be the answer” as large insurance companies seek ways to more […]

What Optum’s $5.4B LHC Group Acquisition Says About the Future of Skilled Nursing Care

Optum, the health services arm of UnitedHealth Group (NYSE: UNH), has agreed to buy home health giant LHC Group (Nasdaq: LHCG) for a reported $5.4 billion.  The blockbuster deal is the latest indication that the nation’s largest health care payers are driving a shift toward value-based care models that prioritize more services delivered in people’s […]