New & Notable
Payers focus on regulatory compliance ahead of 2026
In addition to regulatory pressure, payers are focused on rising healthcare costs, member engagement and investments in AI heading into the new year.
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.
CMS proposes overhauling Medicare Advantage star ratings
The agency suggested cutting a dozen quality measures where health plan performance is high and beneficiaries can’t easily distinguish between offerings.
— Healthcare Dive
Medicare Advantage plans see payments rise with chart reviews
A KFF analysis shows that one in six Medicare Advantage enrollees undergoes a chart review, often leading to additional diagnoses that increase payments to plan sponsors.
Historic government shutdown ends, leaving ACA subsidies in limbo
— Healthcare DiveSponsored Sites
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Financial Responsibility
CareCredit
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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.
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Huron
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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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ACA Marketplaces support care access for kids, parents
With enhanced premium tax credits at risk, families that rely on ACA Marketplace coverage could lose access to healthcare services.
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7 in 10 patients concerned AI will drive unfair claims denials
While patients worry about AI fairness, they recognize the potential the technology has to increase efficiency and potentially access to care.
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Cigna to drop prescription drug rebates for 2027 plan year
The payer said it will instead offer up-front discounts at the pharmacy counter to better reduce costs for patients.
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Do MA Star Ratings incentivize consistent quality performance?
Data shows MA plans move in and out of MA Star Ratings thresholds for lucrative bonus payments, suggesting a potential flaw in the rating system.
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Family premiums for employer coverage jump 6% in 2025
Annual family premiums for employer-sponsored health insurance reached an average of nearly $27,000 in 2025, KFF's annual benchmark survey revealed.
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MA markets getting less crowded, but to minimal cost benefit
Medicare Advantage is getting more competitive, but less concentration has not yielded significant results for the Medicare program and its beneficiaries, according to a new study.
Features
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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.
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What's ahead for prior authorizations as new requirements loom
CMS will require faster decisions and electronic data exchange for prior authorizations; however, providers question whether the requirements will relieve their heavy burden.