New & Notable
Prior authorization denials vary widely among insurers, first-of-its-kind data shows
KFF analyzed new federal prior authorization data and found significant variation in how insurers handle requests across Medicare Advantage, Medicaid, and the ACA markets.
— Healthcare Dive
Trump administration cuts Medicaid funding for youth gender-affirming care
The CMS rule eliminates federal funding for services like puberty blockers and surgeries for minors, though states can still cover the services with their own dollars.
— Healthcare Dive
Employers eye ICHRAs, but affordability remains a concern
More than one-third of employers offering health benefits are at least evaluating an ICHRA, although marketplace instability and costs are hindering adoption.
80% of adults unfamiliar with Medicaid work requirements
Medicaid work requirements are set to begin in January, putting pressure on states to educate members about the program requirements to prevent loss of coverage.
CMS moves to codify limits on Medicaid provider taxes
— 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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Interoperability
Veradigm Network to Payer
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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.
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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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.
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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.
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3.8M qualify for Medicare GLP-1 Bridge at program's July start
With 3.8M Medicare enrollees qualifying for the GLP-1 Bridge, the program could lay the groundwork for future payment models for the weight loss drugs.
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.