New & Notable
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.
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.
Study: Bariatric surgery beats GLP-1s on long-term costs, outcomes
Bariatric surgery costs $109 less per month than GLP-1 drugs for obesity and diabetes patients, with faster weight loss and better outcomes over 12 years, study finds.
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.
States sue Trump administration over Medicaid work requirements rule
— Healthcare DiveSponsored 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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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.
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RCM Management
ZOLL Data Systems
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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OIG: Medicaid managed care provider directories have inaccuracies
Medicaid managed care plan provider directories contain inaccuracies about in-network maternity care providers and their contact information.
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Top Medicare Advantage plans deny up to 80% of rehab requests
CVS Health, Humana and UnitedHealth Group had rehab request denial rates nearly twice those of other Medicare Advantage plans.
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ACA tax credit lapse led to fewer signups, more plan drop-off
Following the lapse of the ACA enhanced premium tax credits, there was a signup shortfall of 1.5 million, but more plan drop-off is expected, according to the Commonwealth Fund.
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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.
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.