New & Notable
Consumers are less satisfied with their health plans: JD Power
Rising costs are eroding Americans’ trust in their commercial plans despite an industry-wide push to increase consumer satisfaction, the analytics firm found.
— Healthcare Dive
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.
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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RCM Management
ZOLL Data Systems
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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.
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Latest News
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Feds hold states to the fire over Medicaid fraud as CA loses $1B
The White House wants proof that states are aggressively pursuing Medicaid fraud, threatening to stop funding if they don't take it seriously enough.
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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.
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.