New & Notable
Aetna to pay $117.7M to settle Medicare Advantage false claims case
The Department of Justice said Aetna submitted inaccurate diagnosis codes to untruthfully inflate its risk pool.
Clover Health becomes first payer to go live on CMS aligned network
Clover Health has become the first payer to meet CMS's interoperability standard and has begun responding to patient requests for clinical and claims data using FHIR formats.
OBBBA's impact on state Medicaid funds varies nationwide
The law will impact states differently depending on their current Medicaid budgeting tactics, ultimately cutting coverage for 7.6 million people by 2034.
Brian Evanko to succeed David Cordani as CEO of Cigna
Evanko, currently COO of Cigna, will assume the chief executive role after Cordani retires in July.
— Healthcare DiveSponsored Sites
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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Aetna launches digital onboarding to boost member experience
Aetna's investment in digital onboarding is indicative of a growing payer trend toward enhanced digital member experiences.
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CMS to crack down on ACA plan marketing, tighten income verifications
The proposed notice of benefit and payment parameters for 2027 would tighten marketing for ACA plans and income verification rules for consumers seeking assistance with marketplace coverage.
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Nearly 45% of healthcare payments tied to APMs: Survey
The latest healthcare payments data shows stable participation in alternative payment models, although there was little growth in risk-based payments.
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Humana taps Google Cloud's agentic AI for member experience
Humana's Agent Assist uses agentic AI technology from Google Cloud to help member experience advocates manage high call volumes.
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Orgs with more MA patients face more readmission penalties
Deeper Medicare Advantage penetration changes the risk pool for hospitals, leading to higher penalties in the Hospital Readmissions Reduction Program, data shows.
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Medicaid improper payments increase, reaching $37.39B
Medicaid, CHIP and Medicare Advantage all saw increases in improper payment rates in FY 2025, while Medicare fee-for-service's rate remained below 10%.
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.