New & Notable
Self-funded employers pay the price for IDR problems
A new report finds that self-funded employers are struggling to manage the volume and added costs of the federal IDR process.
New lawsuit targets Medicaid work requirements’ medical frailty rules
The new lawsuit, filed on behalf of five Medicaid enrollees and a swath of provider groups, says the CMS narrowed exemptions for those too sick to fulfill upcoming work requirements in the program.
— Healthcare Dive
Federal watchdog accuses Humana, UnitedHealthcare Medicare Advantage plans of upcoding
Newly released HHS OIG audits of HumanaChoice and UnitedHealthcare of Wisconsin found both plans frequently exaggerated the health needs of their members.
— Healthcare Dive
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.
2.3M young adults could lose Medicaid due to Big Beautiful Bill: study
— Healthcare DiveSponsored Sites
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Autonomous Coding
Solventum
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Social Determinants of Health
PointClickCare
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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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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.
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Employee health benefits to spike 9.5% in 2027
Researchers said employers will work on benefit design and overall employee wellness to try to cap the rising cost of employee health benefits.
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Medicare Advantage member satisfaction lags for second consecutive year
Experts say poor member satisfaction and engagement have damaged overall consumer trust in their Medicare Advantage plans.
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Employers eye ICHRAs, but affordability remains a concern
More than one-third of employers offering health benefits are at least evaluating an ICHRA, although marketplace instability and costs are hindering adoption.
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80% of adults unfamiliar with Medicaid work requirements
Medicaid work requirements are set to begin in January, putting pressure on states to educate members about the program requirements to prevent loss of coverage.
Features
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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.
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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.