New & Notable
Aetna: Docs trust payers more even as administrative burden persists
Although providers are trusting payers more, there's an opportunity for health IT to ameliorate administrative burdens, including prior authorizations.
Civil rights groups: ACA, Medicaid cuts exacerbate health disparities
Of the nearly 15 million people slated to lose ACA or Medicaid coverage, 60% will come from minority groups, which could worsen racial health disparities.
Health plans fall short in maternity care member communication
Health plans and their members have different ideas of what constitutes good member communication during pregnancy, a new report shows.
ACA premiums set to surge 14% as tax credits expire
Payers offering ACA Marketplace plans proposed another double-digit premium increase, driven by rising healthcare costs, labor shortages and the lapse of enhanced premium tax credits.
States sue Trump administration over Medicaid work requirements rule
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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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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.
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Latest News
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ACA Marketplace premiums might see a double-digit spike in 2027
The early look at ACA Marketplace premiums shows that the tax credit lapse and rising medical cost trend could lead to high premium costs for consumers in 2027.
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As No Surprises Act rules tighten, Zelis expands AI role in dispute process
Zelis launches an AI-powered platform for No Surprises Act disputes as insurers face new compliance demands and scrutiny over reimbursement practices.
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RAND: State Medicaid funding to fall 5% or more for half of the U.S.
State Medicaid funds are slated to fall by $679B through 2034, with 26 states facing cuts of 5% or more, while a select few are expected to see a boost, RAND reports.
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OIG: Medicaid managed care provider directories have inaccuracies
Medicaid managed care plan provider directories contain inaccuracies about in-network maternity care providers and their contact information.
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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.
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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.
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.