New & Notable
CMS framework aims to clarify Medicaid work requirements
The framework adds some specificity around Medicaid work requirement exemptions, but stakeholders say it's still unclear what constitutes medical frailty.
Massachusetts sues UnitedHealthcare for alleged Medicaid fraud
The state claims UnitedHealthcare inflated the sickness of seniors enrolled in MassHealth managed care plans to reap at least $100 million in improper payments.
— Healthcare Dive
ICHRAs enter the mainstream market with broker support
Most brokers are now actively recommending ICHRAs as an alternative to traditional employer-sponsored coverage as employers face double-digit medical cost growth.
GLP-1s, outpatient utilization spur healthcare cost growth in 2026
The cost of care for a person on an employer-sponsored health plan grew 8% in 2026, with premiums hitting $2,295. GLP-1s and more outpatient care are the likely culprits.
CMS finalizes major changes to ACA exchanges, including greater access to catastrophic plans
— Healthcare DiveSponsored Sites
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Interoperability
Veradigm Network to Payer
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Social Determinants of Health
PointClickCare
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Risk Adjustment Compliance
RAAPID
RAAPID develops AI-powered risk adjustment solutions for healthcare payers, providers, and supporting organizations. The company's HITRUST-certified platform uses Neuro-Symbolic AI to identify chronic conditions, determine HCC codes, and provide explainable documentation for complete audit defense. Backed by M12 (Microsoft's venture fund), RAAPID serves organizations participating in Medicare Advantage, ACA, Medicare ACO, and Medicaid programs with both retrospective and prospective risk capture capabilities. Founded by healthcare technology veterans with over 20 years of experience, RAAPID is headquartered in Louisville, Kentucky.
Healthcare Strategies: A Podcast
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A podcast for healthcare professionals seeking solutions to today's and tomorrow's top challenges. Hosted by the editors of Xtelligent Healthcare Media, this podcast series focuses on real-world use cases that are leading to tangible improvements in care quality, outcomes, and cost.
Guests from leading provider, payer, government, and other organizations share their approaches to transforming healthcare in a meaningful and lasting way.
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Latest News
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Medicaid managed care plans fall short of AUD, OUD coverage policies
Despite state policies requiring coverage for certain alcohol and opioid use disorder medicines, Medicaid managed care plans don't always adhere.
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United promises another 30% cut to prior auths in 2026
United will eliminate prior authorizations for more outpatient, chiropractic and diagnostic care this year as part of a pledge to streamline the process.
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Most people benefit from the ACA's free preventive services
A new report shows that a majority of privately insured patients used at least one preventive service covered by the ACA, saving thousands on out-of-pocket costs.
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How are states preparing for Medicaid work requirements?
A recent KFF report outlined the variable strategies states have adopted to implement Medicaid work requirements, ranging from enforcement to IT adoption.
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Payers promise standardized electronic prior auths
After announcing an 11% reduction in prior authorizations, major payers are now focusing on standardizing an electronic request process.
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CMS accelerates Medicare coverage for breakthrough medical devices
The agency and FDA announced a new Medicare coverage pathway for certain breakthrough medical devices that cuts the reimbursement timeline from 1+ years to months.
Features
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5 healthcare pros on the trends defining primary care
The 2025 Payer + Provider Virtual Summit explored AI, value-based care and community-based partnerships, offering strategies on how to promote primary and preventive care.
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How payers can regain consumer trust via personalized care
Creating personalized health plans is central to regaining consumer trust. To do that, payers must outline safeguards for member data and create seamless experiences.
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With trust low and costs high, do payers stand to lose members?
Healthcare payers might see fewer enrollments as members face higher prices for a product they don't trust or see as high value.
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Breaking down the ABCs of rising alternative health plans
More employers are seeking alternative health plans, like AHPs and ICHRAs, to bend the cost curve, but education is key to navigating their growing popularity.