New & Notable
States sue Trump administration over Medicaid work requirements rule
Twenty-six states are seeking to overturn some of the regulation released by the CMS this month that outlined Medicaid work requirements.
— Healthcare Dive
HHS cut 3M ACA Marketplace enrollments in ongoing fraud efforts
The agency said it rooted out fraudulent Affordable Care Act enrollments following the 2025 Trump rule that laid out stricter eligibility, enrollment and enforcement standards.
ACA Marketplace premiums might see a double-digit spike in 2027
The early look at ACA Marketplace premiums shows that the tax credit lapse and rising medical cost trend could lead to high premium costs for consumers in 2027.
As No Surprises Act rules tighten, Zelis expands AI role in dispute process
Zelis launches an AI-powered platform for No Surprises Act disputes as insurers face new compliance demands and scrutiny over reimbursement practices.
Sponsored Sites
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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.
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Interoperability
Veradigm Network to Payer
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Social Determinants of Health
PointClickCare
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.
View All Episodes
Latest News
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CMS received nearly 15K NSA complaints, mostly against providers
Most complaints alleging PHS Act violations are related to the No Surprises Act, with tens of thousands of allegations made against providers, CMS reports.
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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.
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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.
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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.
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Two USPSTF leaders fired, sparking concern about panel's credibility
The ouster of two U.S. Preventive Services Task Force members is sparking concern among population health experts who worry the panel may no longer be independent.
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ACA Marketplace deductibles increased by over $1K: KFF
The expiration of enhanced premium tax credits is increasing ACA Marketplace deductibles as enrollment hits an all-time low, KFF reports.
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.