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What We're Reading: 2 More Co-Ops Sue Obama Administration
What we're reading, August 2, 2016: co-ops in New Mexico and Massachusetts sue the government over the risk-adjustment formula and why hospital ratings should be viewed with a bit of skepticism.
Co-ops in New Mexico and Massachusetts are suing the Obama administration over the management of the program. The states join Maryland, which filed a similar lawsuit in June, arguing that the “risk adjustment” formula overly rewarded big insurers, reported The Wall Street Journal. The co-ops are alleging that CMS hindered their success through the risk-adjustment program. The executives are saying they shouldn’t have to make payments to the government for 2015 based on the current system.
CMS recently released its “Star” ratings for hospital quality, but hospital ratings should be viewed with a bit of skepticism. While information may seem objective, the data points used and how they are weighted can lead to contradictory conclusions, STAT explains. Furthermore, opponents of CMS’ rating system have already made the case that the system penalizes hospitals that treat more low-income patients.
AI in Health Care: Balancing Governance, Innovation, and Trust
September 2nd 2025In this conversation with Reuben Daniel, associate vice president of artificial intelligence at UPMC Health Plan, we dive into how UPMC Health Plan builds trust with providers and members, discuss challenges of scaling AI effectively, and hear about concrete examples of AI's positive impact.
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Infertility Coverage Boosts ART Use and Pregnancy Success: Richard A. Brook, MS, MBA
August 26th 2025In this episode, Richard A. Brook, MS, MBA, discusses his study showing that infertility treatment coverage increases assisted reproductive technology (ART) use and improves pregnancy outcomes.
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