New & Notable
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.
Black, Hispanic patients underrepresented in value-based care models
White, high-income patients living in urban areas are more likely to benefit from value-based care models, limiting the generalizability of model results.
State-based subsidies saved some ACA Marketplace losses
States that offered their own subsidies to consumers had lower ACA Marketplace enrollment losses, according to new KFF data.
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.
CMS moves to codify limits on Medicaid provider taxes
— Healthcare DiveSponsored Sites
-
Autonomous Coding
Solventum
-
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.
-
Social Determinants of Health
PointClickCare
Healthcare Strategies: A Podcast
-
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
-
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.
-
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.
-
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.
Features
-
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.
-
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.
-
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.
-
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.