New & Notable
Judge strikes down CMS ‘medical frailty’ policy for Medicaid work requirements
It’s a victory for more than two dozen states that had sued to block the definition, along with providers, consumer advocates and other critics that had opposed it.
— Healthcare Dive
Docs' trust in payers holds steady, but patient data access gaps persist
The Aetna report also showed improvement in provider experiences with prior authorization, contributing to the steady trust score providers give their payers.
Employee health insurance premium costs soar 9% this year
Rising employee premium costs indicate a tumultuous public and private insurance sector, with KFF researchers urging policies to lower costs across the board.
Uninsured rate rises to 11% ahead of Medicaid work requirements
Cuts to federal programs and the loss of enhanced subsidies on the exchanges could deepen an existing healthcare affordability crisis, according to a new report from the Commonwealth Fund.
— Healthcare DiveGhost networks haunt mental health access, study finds
— Healthcare DiveCentene joins insurers waiving prior authorizations for top providers
— 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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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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Medicare patients have good healthcare experiences, fueling universal coverage debate
The Commonwealth Fund found that Medicare enrollees have healthcare experiences similar to those of their peers abroad, calling into question how the federal program could improve experiences for all patients.
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HHS flags 340B spread pricing, consolidation concerns
An HHS report finds the 340B program has strayed from its original intent, favoring hospital profit over patients, as spread pricing drives soaring costs and participation.
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Medical coding, GLP-1s push BCBSMA spending up 12%
Blue Cross Blue Shield of Massachusetts documents a rapid growth in healthcare spending after COVID-19 in a new study, which points to rises in medical and GLP-1 utilization.
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New Cigna tool links member data for personalized health management
Cigna said its Health Sense tool will cut 10% of inefficient spending by synthesizing member and benefits data and providing personalized health management.
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Neb. Medicaid work requirements yield 7% coverage losses
Since implementing Medicaid work requirements in May, Nebraska has also denied 14% of new Medicaid coverage applications.
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Texas AG opens prior auth probe into Blue Cross Blue Shield of Texas
Texas Attorney General Ken Paxton said his office has received reports about denied or delayed coverage for services that are medically necessary or urgent.
Features
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Aetna CTO talks prior auth AI strategy, AI governance
Aetna chief technology officer Nathan Frank says the payer has a product- and business-first approach to AI, steering clear of AI for AI's sake.
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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.
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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.