New & Notable
Payers promise standardized electronic prior auths
After announcing an 11% reduction in prior authorizations, major payers are now focusing on standardizing an electronic request process.
CMS accelerates Medicare coverage for breakthrough medical devices
The agency and FDA announced a new Medicare coverage pathway for certain breakthrough medical devices that cuts the reimbursement timeline from 1+ years to months.
CMS benches BALANCE Model for Medicare
The federal agency announced an indefinite delay to the Medicare Part D portion of the upcoming model that would expand coverage criteria for GLP-1s.
UnitedHealthcare eliminates prior authorization for rural providers
In addition to scrapping prior authorization, UnitedHealthcare said it will speed up payments and create more community-based care models for rural providers.
Sponsored Sites
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Specialty Drug Management
Optum Specialty Fusion
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Social Determinants of Health
PointClickCare
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Revenue Cycle Management
Brault
Brault is a revenue cycle and practice management organization that partners with hospitals and independent physician groups. Their intelligent practice solutions include coding and billing, MIPS optimization, provider documentation training, and practice management.
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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CMMI has lost $5.4B. Now, lawmakers are questioning its value.
A new GAO report found a 5% success rate for models tested by the CMS Innovation Center, prompting lawmakers to consider reform to advance value-based care.
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After ACA subsidy lapse, consumers opt for low-cost Marketplace plans
The number of patients selecting low-cost, high-deductible ACA marketplace plans rose from 30% to 40% for the 2026 Open Enrollment Period.
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UnitedHealthcare launches AI chatbot for member care navigation
UnitedHealthcare said the AI chatbot will support customer advocates by handling simple care navigation tasks and referring members to advocates when needed.
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CMS introduces value-based pediatric model for Medicaid
The new ASPIRE model will award five state Medicaid agencies with $125M to coordinate the care for children with complex medical and behavioral needs.
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High costs, more uninsured without enhanced premium tax credits
A new KFF survey reveals significantly higher costs following the expiration of enhanced subsidies for Marketplace plans, with more enrollees dropping coverage this year.
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UnitedHealthcare expands doula benefit to support maternal health
UnitedHealthcare will expand its doula benefit to certain employer-sponsored health plans as part of the payer's strategy to improve maternal health outcomes.
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.