New & Notable
Trump administration revamps insurer price transparency reporting
On Monday, the HHS and Labor and Treasury Departments finalized a rule meant to strip out junk cluttering cost disclosures, among other reforms. Employers cheered the changes.
— Healthcare Dive
Neb. Medicaid work requirements yield 7% coverage losses
Since implementing Medicaid work requirements in May, Nebraska has also denied 14% of new Medicaid coverage applications.
Texas AG opens prior auth probe into Blue Cross Blue Shield of Texas
Texas Attorney General Ken Paxton said his office has received reports about denied or delayed coverage for services that are medically necessary or urgent.
Here’s how much insurers are cutting Medicare Advantage plans for 2027
Newly released CMS data gives the market its first comprehensive look at how insurers are adapting to continued pressure in the privatized Medicare program.
— Healthcare DiveNew lawsuit targets Medicaid work requirements’ medical frailty rules
— Healthcare DiveFederal watchdog accuses Humana, UnitedHealthcare Medicare Advantage plans of upcoding
— Healthcare DiveSponsored Sites
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Interoperability
Veradigm Network to Payer
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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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Cybersecurity
Commvault + Microsoft
Together, Commvault and Microsoft are redefining cybersecurity and data resilience with a comprehensive, integrated platform, purpose-built to secure, defend, and recover data wherever it lives with true cloud simplicity, intelligence, and scale.
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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New IDR portal sign-ups open for No Surprises Act disputes
The CMS has opened registration for the IDR Gateway, a centralized platform for parties to manage No Surprises Act disputes, which will formally open in late 2026.
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62% of young members use AI to choose a health plan
Health plans risk $3 billion in future member lifetime value if they continue to fall short on trust, opening the door for members to build relationships with AI.
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Seasonal work risks Medicaid work requirement compliance
One in five adults at risk of noncompliance with Medicaid work requirements already work, with their hours just missing the 20-hour requirement set out by CMS.
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Medicare GLP-1 program sees rapid uptake among seniors
CMS Administrator Mehmet Oz says 600,000 seniors have signed up for discounted GLP-1s through Medicare Bridge, projecting taxpayer savings through reduced hospitalizations.
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Cigna links supplemental benefits with medical plans
In 2027, employers can offer Medical with Smart Coverage, which allows them to connect supplemental benefits to high-deductible health plans.
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How employers are rethinking benefits as healthcare costs soar
A new survey shows that employers are looking to value-based models, deeper vendor partnerships and potentially alternative health plans to control rising healthcare costs.
Features
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Aetna CTO talks prior auth AI strategy, AI governance
Aetna chief technology officer Nathan Frank says the payer has a product- and business-first approach to AI, steering clear of AI for AI's sake.
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Can Costco hack Medicare Advantage's consumer loyalty problems?
Costco announced it'll sell Medicare Advantage plans in partnership with SCAN Health Plan, testing the wholesaler's consumer loyalty in a new market.
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Inside Elevance's digital chronic disease management strategy
The payer uses multiple chronic disease management programs to avoid a one-size-fits-all approach to member engagement.
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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.