New & Notable
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.
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.
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.
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Cybersecurity
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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.
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Latest News
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High costs, more uninsured without enhanced premium tax credits
A new KFF survey reveals significantly higher costs following the expiration of enhanced subsidies for Marketplace plans, with more enrollees dropping coverage this year.
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UnitedHealthcare expands doula benefit to support maternal health
UnitedHealthcare will expand its doula benefit to certain employer-sponsored health plans as part of the payer's strategy to improve maternal health outcomes.
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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.
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.