California Watch
News stories in this section spotlight activities in California, including actions by the state Assembly and state Senate; proposed legislation; regulators like the Department of Managed Health Care and Department of Insurance; and the state ACA exchange, Covered California.
Blue Shield of California CEO Lois Quam is stepping down after two months on the job. The nonprofit health plan will begin a search for a permanent CEO and has appointed CFO Mike Stuart as interim president and CEO, according to a March 11 news release. Mr. Stuart was appointed Blue Shield’s CFO in 2022 and previously ...
Two companies have agreed to a $1.3 million settlement after they were accused of selling “sham” health insurance plans, the California Department of Justice said. According to the CA DOJ, Sedera, Inc. and Sedera Medical Cost Sharing Community, LLC (SMC) billed customers monthly in exchange for the payment of medical services, a plan which they ...
According to reporting by The Mercury News, one of California’s leading daily newspapers, about one-fourth of all health insurance claims in the Golden State were denied last year. Some may have been denied due to Artificial Intelligence (AI). However, new legislation prohibits health insurers from relying solely on AI to deny a claim based on medical necessity. ...
Shortly before returning to the courtroom, Sutter Health has reached an “agreement in principle” to settle a long-running and recently revived antitrust class-action lawsuit, according to a Sunday evening legal filing and statement from the legal counsel for the plaintiffs shared Monday morning. The case, Sidibe et al v. Sutter Health, was filed in the ...
Proposed legislation could make California one of only a handful of states that require insurers to disclose denial rates and reasoning, which the industry often considers proprietary information.
As lawmakers scrutinize the nation's pharmacy benefit managers, the California insurer expects to save $500 million in annual drug costs by replacing most of CVS Health's PBM services by January 2025.
A powerful California lawmaker wants to regulate how artificial intelligence systems interact with health plan participants. Assemblymember Mia Bonte, a Democrat who chairs the assembly’s Health Committee, has introduced a bill that would keep the developers and users of AI systems from having the AI systems imply that they are doctors, nurses or other types ...
Sutter Health will invest $1 billion to expand its services across Northern California’s East Bay region, including a new flagship campus in Emeryville. The health system announced Wednesday that the campus will feature a new medical center with up to 200 beds as well as a regional destination for ambulatory care. The plans also leave ...
California Gov. Gavin Newsom and state legislators in Sacramento seem to agree: Prescription drug prices are too high. But lawmakers and the second-term governor are at odds over what to do about it, and a recent proposal could trigger one of the biggest health care battles in Sacramento this year.
In an unprecedented collaboration, three leading California health plans — Aetna, Blue Shield of California and Health Net — have united to co-implement a shared value-based payment model under the California Advanced Primary Care Initiative’s Payment Model Demonstration Project. Led by the California Quality Collaborative (CQC) and the Integrated Healthcare Association (IHA), the new payment model will span 11 provider ...