New & Notable
Ghost networks haunt mental health access, study finds
A secret shopper study found less than a quarter of calls to mental health clinicians resulted in appointments, with directory errors and unreachable providers driving so-called “ghost” networks.
— Healthcare Dive
CMS proposes rule to clean up MA provider directories, shine light on PBMs
The proposed changes would implement key healthcare provisions in a government funding package from February.
— Healthcare Dive
Confusion around how to adhere to new Medicaid rules persists, survey shows
While Americans know about changes to Medicaid work requirements, many are unsure who the new rules apply to and how to comply with them to ensure they keep their coverage.
Trade association sues Trump administration over ACA broker, agent freeze
The National Association of Benefits and Insurance Professionals alleges that the HHS violated the law by not giving the public a chance to comment on the controversial policy.
— Healthcare DiveCentene joins insurers waiving prior authorizations for top providers
— Healthcare DiveHumana soars, Alignment plummets in 2027 Medicare Advantage star ratings
— Healthcare DiveSponsored Sites
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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.
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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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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.
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Cigna, OpenAI partner on AI-driven personalized cancer care
OpenAI's technology will draw on Cigna's data and care management capabilities to produce individualized outreach and engagement.
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AHIP: Medical costs, prescription drugs dominate premium dollar spend
The payer industry's primary lobbyist outlined a cent-by-cent breakdown of premium dollar spending, claiming hospital and prescription drug costs are the biggest expenses.
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Self-funded employers pay the price for IDR problems
A new report finds that self-funded employers are struggling to manage the volume and added costs of the federal IDR process.
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.