New & Notable
How employers are rethinking benefits as healthcare costs soar
A new survey shows that employers are looking to value-based models, deeper vendor partnerships and potentially alternative health plans to control rising healthcare costs.
Employee health benefits to spike 9.5% in 2027
Researchers said employers will work on benefit design and overall employee wellness to try to cap the rising cost of employee health benefits.
Can Costco hack Medicare Advantage's consumer loyalty problems?
Costco announced it'll sell Medicare Advantage plans in partnership with SCAN Health Plan, testing the wholesaler's consumer loyalty in a new market.
Medicare Advantage member satisfaction lags for second consecutive year
Experts say poor member satisfaction and engagement have damaged overall consumer trust in their Medicare Advantage plans.
Prior authorization denials vary widely among insurers, first-of-its-kind data shows
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Specialty Drug Management
Optum Specialty Fusion
At Optum, we’re evolving health care so everyone can have the opportunity to live their healthiest life. It’s why we put your unique needs at the heart of everything we do, making it easy and affordable to manage health and well-being. Together, for better health.
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Interoperability
Veradigm Network to Payer
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Revenue Cycle Management
Greenway Health
Improving healthcare through innovation is at the heart of Greenway Health’s work. We provide electronic health records (EHR), practice management, and revenue cycle management solutions that help practices in multiple specialties grow profitably, remain compliant, work more efficiently, and improve patient outcomes.
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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CMS fraud war room stops $203M in debated Medicaid payments
In less than 90 days, the new Medicaid Fraud War Room blocked payments to 50 unique providers at high-risk of defrauding the federal healthcare program, the CMS says.
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OIG calls on states to tamp down Medicaid provider fraud
States must create more specific contracts with Medicaid MCOs detailing requirements for Medicaid provider fraud referrals, OIG advised.
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Aetna: Docs trust payers more even as administrative burden persists
Although providers are trusting payers more, there's an opportunity for health IT to ameliorate administrative burdens, including prior authorizations.
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Civil rights groups: ACA, Medicaid cuts exacerbate health disparities
Of the nearly 15 million people slated to lose ACA or Medicaid coverage, 60% will come from minority groups, which could worsen racial health disparities.
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Health plans fall short in maternity care member communication
Health plans and their members have different ideas of what constitutes good member communication during pregnancy, a new report shows.
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ACA premiums set to surge 14% as tax credits expire
Payers offering ACA Marketplace plans proposed another double-digit premium increase, driven by rising healthcare costs, labor shortages and the lapse of enhanced premium tax credits.
Features
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Inside Elevance's digital chronic disease management strategy
The payer uses multiple chronic disease management programs to avoid a one-size-fits-all approach to member engagement.
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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.