New & Notable
Orgs with more MA patients face more readmission penalties
Deeper Medicare Advantage penetration changes the risk pool for hospitals, leading to higher penalties in the Hospital Readmissions Reduction Program, data shows.
CMS proposes excluding chart reviews from MA risk scoring in 2027 payment rule
If finalized, the proposal would eliminate the financial motivation insurers have to mine their members’ charts for additional diagnoses, disproportionately affecting UnitedHealthcare.
— Healthcare Dive
Medicaid improper payments increase, reaching $37.39B
Medicaid, CHIP and Medicare Advantage all saw increases in improper payment rates in FY 2025, while Medicare fee-for-service's rate remained below 10%.
Medicare Advantage overpayments will total $76B this year: MedPAC
The federal government will pay an estimated $76 billion more to cover Medicare Advantage seniors this year than it would if those same seniors were in traditional Medicare, according to new estimates from an influential advisory group.
— Healthcare DiveTrump unveils healthcare affordability plan
— Healthcare DiveSponsored Sites
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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Anthem sues 11 hospitals over No Surprises Act disputes
Anthem accused Prime Healthcare hospitals of flooding the IDR process with ineligible claims, resulting in $15M more in payments for out-of-network care.
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Trump administration ups payer price transparency requirements
The federal government proposed major updates to the Transparency in Coverage rule, including data disclosure changes for in-network rates and more robust consumer-friendly disclosure.
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AMA: 97% of U.S. commercial markets highly concentrated in 2024
Limited competition in the health insurer market is driving rising costs and fewer options for patients, the AMA warned in a new study.
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Tips for employers weighing GLP-1 coverage, health IT vendors
Employers should assess health IT vendors that can tailor GLP-1 coverage pathways, provide lifestyle support and guide users discontinue use.
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Employer-sponsored insurance costs outpaced inflation in 2024
Experts state that spikes in employer-sponsored insurance premiums will strain employees' pocketbooks again this year.
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Aetna, Cigna, United called out for price transparency failures
A study rates Aetna, Cigna and UnitedHealthcare on compliance with Transparency in Coverage requirements, finding major gaps among all three major U.S. payers.
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.