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Author: Lauren Brown

Blue Cross Blue Shield Updates Highlight Financial Pressure, Policy Shifts Across Southern States

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Blue Cross Blue Shield (BCBS) plans continue to face financial strain and policy changes across multiple states, with several developments in the South reflecting ongoing cost pressures, reimbursement adjustments, and pharmacy initiatives. Financial and Performance Trends in Southern States BCBS plans in southern states show mixed financial results as medical and pharmacy costs rise: Leadership Changes in Southern Markets Several southern BCBS-affiliated plans are experiencing executive turnover: Policy and Legal Developments Affecting Southern States Southern…
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Orlando Health Expands Alabama Presence with Planned RMC Health System Acquisition

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Orlando Health is continuing its expansion in Alabama with plans to acquire RMC Health System, a nonprofit system anchored by a 375-bed medical center and a broad network of outpatient and specialty services. The transaction, expected to close this fall, will further strengthen Orlando Health’s growing footprint in the state. This move builds on Orlando Health’s earlier investment in Brookwood Baptist Health, where it acquired a majority stake from Tenet Healthcare in 2024. With RMC…
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CMS Flags Billing Risks for E/M Services and Expands Innovation Model Flexibility

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The Centers for Medicare & Medicaid Services and the Office of Inspector General are drawing attention to improper billing practices involving evaluation and management (E/M) services billed alongside intravitreal injections. Recent findings show that modifier 25 has been incorrectly applied in cases where the E/M service was not truly separate from the procedure, increasing the risk of improper payments and audit exposure. Providers are reminded that modifier 25 should only be used when documentation clearly…
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CMS Signals Tighter Medicare Advantage Payment Growth with 2027 Rate Update

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The Centers for Medicare & Medicaid Services (CMS) has finalized a 2.48% payment increase for Medicare Advantage (MA) plans in 2027, a notable shift from prior years’ larger hikes and a clear signal of increased scrutiny on plan payments and coding practices. CMS leadership, including Chris Klomp, emphasized that sustained, high growth in MA rates is unlikely moving forward. Industry Context With nearly 35 million beneficiaries enrolled in MA plans, the program now represents a…
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CMS Innovation Models Introduce New Incentive for Clinician-Guided Hemp-Derived Product Access

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The Centers for Medicare & Medicaid Services (CMS) has launched a new, optional Substance Access Beneficiary Engagement Incentive (BEI) within select Innovation Center models, allowing participating providers to incorporate eligible hemp-derived products into patient care plans under clinician guidance. The initiative is now available to organizations in the ACO REACH Model and Enhancing Oncology Model, with expansion to the Long-term Enhanced ACO Design Model planned for 2027. Resource: CMS Marks Milestone in Expanding Patient-Centered Innovation…
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Flu Activity Declines Nationwide, but Pediatric Impact Remains Elevated

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The Centers for Disease Control and Prevention (CDC) reports that influenza activity across the U.S. is continuing to trend downward, signaling a potential close to the peak of the current flu season. Positivity rates and outpatient visits for flu-like illness have both declined and are now below national baseline levels, reflecting typical seasonal patterns. Key Trends from the Latest Data Ongoing Concerns Despite overall improvement, pediatric impact remains notable. Additional reported deaths have pushed the…
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Expanding Impact of GLP-1 Therapies: 13 Potential Benefits to Watch

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Medications in the GLP-1 class—such as Ozempic, Wegovy, Mounjaro, and Zepbound—are already widely used for diabetes and weight management, but new research points to a much broader clinical impact. A recent analysis from The Washington Post highlights emerging evidence that these therapies may influence multiple chronic conditions beyond their current FDA-approved uses. Key Areas of Potential Benefit Research to date identifies 13 areas where GLP-1 medications show varying levels of promise: What This Means for…
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Nursing Leaders Prioritize Virtual Care Roles in 2026 Workforce Planning

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A new report from Wolters Kluwer highlights a clear shift in nursing workforce strategy, with chief nursing officers (CNOs) placing the highest hiring priority on virtual care roles in 2026. Based on a survey of 150 hospital and health system leaders, telehealth and virtual nursing positions are emerging as critical to care delivery and operational efficiency. Top Nursing Roles in Demand for 2026 What This Means for Healthcare Organizations The growing emphasis on telehealth and…
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‘Cicada’ COVID-19 Variant Detected Across 25 States: What Alabama Providers Should Watch

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The emerging BA.3.2 “Cicada” variant of COVID-19 has been detected in wastewater samples across 25 states, according to the Centers for Disease Control and Prevention. While not yet reported in Alabama, activity in neighboring states signals a potential regional spread that providers should monitor closely. Bordering States to Alabama with Confirmed Detections These detections are based on wastewater surveillance, which serves as an early indicator of community spread. The presence of the variant in nearby…
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Leadership Transition at Crestwood Medical Center Following $459M Acquisition

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Kyle Buchanan has been appointed president of Crestwood Medical Center, a 180-bed hospital, with his new role taking effect April 20. The leadership change follows the recent $459 million acquisition of the facility by Huntsville Hospital Health System from Community Health Systems, signaling a new phase of strategic direction and operational alignment. Bringing more than two decades of healthcare leadership experience, Buchanan is expected to continue driving performance improvements and strengthening physician partnerships—key priorities as…
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CMS Releases Key Guidance on Upcoming Medicaid Eligibility Changes for Noncitizens

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The Centers for Medicare & Medicaid Services (CMS) has issued new operational guidance to help states prepare for significant Medicaid eligibility changes tied to H.R. 1, set to take effect October 1. The policy will narrow federal Medicaid and CHIP funding to specific categories of noncitizens, requiring states to make timely updates across eligibility systems, applications, verification processes, and claims infrastructure. Under the new rules, several groups previously eligible for full Medicaid coverage will no…
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CDC Weighs New Code for COVID-19 Vaccine-Related Injuries

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The Centers for Disease Control and Prevention is considering a proposal to establish a specific medical coding designation for injuries related to COVID-19 vaccines. The initiative, supported by nonprofit React19, aims to improve how potential adverse effects are documented and studied across the healthcare system. If implemented, the new code could help providers more accurately track and manage cases involving significant vaccine-related side effects, while also supporting broader research and data collection efforts. However, some…
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