New & Notable
Insurers get a 2.48% MA pay bump after close call with a flat rate
CMS backtracked on a less than 1% payment rate increase for Medicare Advantage plans, instead finalizing a nearly 2.5% boost and sidestepping risk adjustment changes.
CMS finalizes Medicare Advantage star ratings overhaul, sending billions of dollars more to insurers
Regulators cut almost a dozen metrics that factor into the quality ratings and reverted back to an older and more generous bonus system.
— Healthcare Dive
CMMI has lost $5.4B. Now, lawmakers are questioning its value.
A new GAO report found a 5% success rate for models tested by the CMS Innovation Center, prompting lawmakers to consider reform to advance value-based care.
Bipartisan lawmakers urge CMS to crack down on Medicare Advantage overpayments
Senators praised a recent CMS proposal aimed at reducing payments in MA, but urged the agency to work with Congress and go further.
— Healthcare DiveSponsored Sites
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Social Determinants of Health
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Financial Responsibility
CareCredit
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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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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.
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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.
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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.
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Report: Medicare Advantage growth gives way to SNPs
Medicare Advantage growth slowed in 2026, due in part to scaled-back plan offerings, leading beneficiaries to flock to Special Needs Plans.
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GoodRx offers employers a workaround for GLP-1s, high-cost meds
A new service will allow employers to provide direct subsidies for high-impact, brand-name medications, like GLP-1s, without adding coverage to their insurance plans.
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CMS solicits information on AI tools for Medicare plan selection
The agency is requesting information on AI tools that can enhance the Medicare beneficiary experience, particularly as it relates to selecting plans.
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.