New & Notable
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.
Cigna drops new AI-powered, copay-only health plan
Cigna announces Clearity, a new copay-only health plan that leverages AI tools to engage members and maximize cost savings.
Epic and Humana launch digital health insurance card checks
Epic's Payer Platform will now store coverage information and digital insurance cards for more than 800,000 Humana Medicare Advantage Members.
Historic government shutdown ends, leaving ACA subsidies in limbo
— 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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Specialty Drug Management
Optum Specialty Fusion
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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RCM Management
ZOLL Data Systems
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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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.
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Commonwealth Fund: Medicare member experience varies by state
State-by-state disparities in Medicare experiences are largely driven by the fragmented nature of the U.S. healthcare industry.
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Private payers also pay a lot more for HOPD vs ASC care
A new study finds private payers, similar to Medicare, pay significantly higher rates to HOPDs for common services, although a narrow network led to savings for one national payer.
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.