New & Notable
CMS ousts 2 No Surprises arbiters as critics question impartiality
Earlier this week, the Trump administration denied recertification requests from Island Peer Review Organization and Network Medical Review Company. Insurers cheered the decision.
— Healthcare Dive
Consumers turn to AI to shop for health plans during ACA open enrollment
More consumers are using AI to understand their health plan options, a priority as premiums continue to rise.
Senior GLP-1 use surges 21% following Bridge launch
A new analysis finds growing GLP-1 prescribing rates among seniors after the CMS expanded access under a temporary 18-month program.
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 DiveUninsured rate rises to 11% ahead of Medicaid work requirements
— Healthcare DiveGhost networks haunt mental health access, study finds
— Healthcare DiveSponsored Sites
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Autonomous Coding
Solventum
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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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Revenue Cycle Management
Greenway Health
Improving healthcare through innovation is at the heart of Greenway Health’s work. We provide electronic health records (EHR), practice management, and revenue cycle management solutions that help practices in multiple specialties grow profitably, remain compliant, work more efficiently, and improve patient outcomes.
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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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.
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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.
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.