New & Notable
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.
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.
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.
CMS proposes excluding chart reviews from MA risk scoring in 2027 payment rule
If finalized, the proposal would eliminate the financial motivation insurers have to mine their members’ charts for additional diagnoses, disproportionately affecting UnitedHealthcare.
— Healthcare DiveMedicare Advantage overpayments will total $76B this year: MedPAC
— Healthcare DiveTrump unveils healthcare affordability plan
— Healthcare DiveSponsored Sites
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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.
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Healthcare
Huron
Change is constant in healthcare, and its speed is accelerating. Huron works with healthcare organizations every day to strengthen and innovate their businesses and build more resilient operations to thrive now and in the future.
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Financial Responsibility
CareCredit
We do something very simple at CareCredit: We help people get the care they want for themselves and their families.
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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Medicaid work requirements to cause 1M missed cancer screenings
Medicaid coverage losses will impact how many people can access preventive care, resulting in a million missed cancer screenings.
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Abridge partners with Availity for AI-powered prior authorizations
Abridge took its next step in powering prior authorizations with AI; this time, the company teamed up with Availity to use conversational intelligence for real-time prior authorizations.
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Anthem sues 11 hospitals over No Surprises Act disputes
Anthem accused Prime Healthcare hospitals of flooding the IDR process with ineligible claims, resulting in $15M more in payments for out-of-network care.
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Trump administration ups payer price transparency requirements
The federal government proposed major updates to the Transparency in Coverage rule, including data disclosure changes for in-network rates and more robust consumer-friendly disclosure.
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AMA: 97% of U.S. commercial markets highly concentrated in 2024
Limited competition in the health insurer market is driving rising costs and fewer options for patients, the AMA warned in a new study.
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Tips for employers weighing GLP-1 coverage, health IT vendors
Employers should assess health IT vendors that can tailor GLP-1 coverage pathways, provide lifestyle support and guide users discontinue use.
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.