New & Notable
Feds hold states to the fire over Medicaid fraud as CA loses $1B
The White House wants proof that states are aggressively pursuing Medicaid fraud, threatening to stop funding if they don't take it seriously enough.
Medicaid managed care plans fall short of AUD, OUD coverage policies
Despite state policies requiring coverage for certain alcohol and opioid use disorder medicines, Medicaid managed care plans don't always adhere.
MACPAC calls for increased transparency in Medicaid AI prior authorization
The influential advisory group is recommending policies to boost human oversight and transparency into how Medicaid plans are using AI for prior authorizations.
— Healthcare Dive
United promises another 30% cut to prior auths in 2026
United will eliminate prior authorizations for more outpatient, chiropractic and diagnostic care this year as part of a pledge to streamline the process.
Cigna exits ACA exchanges despite dramatic profit growth in Q1
— Healthcare DiveSponsored Sites
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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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CMS benches BALANCE Model for Medicare
The federal agency announced an indefinite delay to the Medicare Part D portion of the upcoming model that would expand coverage criteria for GLP-1s.
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UnitedHealthcare eliminates prior authorization for rural providers
In addition to scrapping prior authorization, UnitedHealthcare said it will speed up payments and create more community-based care models for rural providers.
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Mental health parity remains elusive in 43 states
In-network mental healthcare is harder to get in most states than physical healthcare, potentially due to disparate provider reimbursement rates.
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Payers face faster prior authorization approvals under CMS proposal
Under the proposed rule, affected payers would need to respond to urgent prior authorization requests for drugs within 24 hours and to standard requests within 72 hours.
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Digital member experience improves for health plans, gaps remain
A recent JD Power survey showed that, although the digital member experience is improving for health plans, there's room to grow for onboarding and patient education.
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Major payers say they cut prior authorizations by 11%
Major Blues plans, Cigna, Humana and United are among the payers reporting reduced prior authorizations amid an industry-wide push to streamline the process.
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.