New & Notable
Top Medicare Advantage plans deny up to 80% of rehab requests
CVS Health, Humana and UnitedHealth Group had rehab request denial rates nearly twice those of other Medicare Advantage plans.
ACA tax credit lapse led to fewer signups, more plan drop-off
Following the lapse of the ACA enhanced premium tax credits, there was a signup shortfall of 1.5 million, but more plan drop-off is expected, according to the Commonwealth Fund.
CMS received nearly 15K NSA complaints, mostly against providers
Most complaints alleging PHS Act violations are related to the No Surprises Act, with tens of thousands of allegations made against providers, CMS reports.
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 DiveMassachusetts sues UnitedHealthcare for alleged Medicaid fraud
— 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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Autonomous Coding
Solventum
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Healthcare
Huron
Change is constant in healthcare, and its speed is accelerating. Huron works with healthcare organizations every day to strengthen and innovate their businesses and build more resilient operations to thrive now and in the future.
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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ACA Marketplace deductibles increased by over $1K: KFF
The expiration of enhanced premium tax credits is increasing ACA Marketplace deductibles as enrollment hits an all-time low, KFF reports.
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ACP calls for Medicare Advantage transparency overhaul
The American College of Physicians urged overhauls to Medicare Advantage that would promote transparency, access to care and healthcare affordability.
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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.
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.