New & Notable
AMA: 97% of U.S. commercial markets highly concentrated in 2024
Limited competition in the health insurer market is driving rising costs and fewer options for patients, the AMA warned in a new study.
Tips for employers weighing GLP-1 coverage, health IT vendors
Employers should assess health IT vendors that can tailor GLP-1 coverage pathways, provide lifestyle support and guide users discontinue use.
Senate rejects competing health bills, setting up ACA subsidy lapse
The failure of bills from both Democrats and Republicans means enhanced subsidies for Affordable Care Act plans will likely expire at the end of the year.
— Healthcare Dive
Employer-sponsored insurance costs outpaced inflation in 2024
Experts state that spikes in employer-sponsored insurance premiums will strain employees' pocketbooks again this year.
Sponsored Sites
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RCM Management
ZOLL Data Systems
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Healthcare
Huron
Change is constant in healthcare, and its speed is accelerating. Huron works with healthcare organizations every day to strengthen and innovate their businesses and build more resilient operations to thrive now and in the future.
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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.
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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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.
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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.
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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.
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Survey: As Medicaid enrollment remains flat, costs boom
A KFF survey of state Medicaid directors found that most states expect Medicaid enrollment to remain flat in FY 2026, although costs are predicted to increase 7.9%.
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Study: Auto-renewals in Medicaid prevented coverage losses
A new study finds an intervention to facilitate automated Medicaid renewals successful during the unwinding process, signaling a potential solution under Trump's new eligibility rules.
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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.
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.