2+ hour, 49+ min ago  (209+ words) Further change in the Star Ratings program is inevitable, but one thing won't change: plans that make targeted investments in improving the member experience and clinical outcomes, driven by data, are the most likely to succeed and achieve a higher…...

1+ day, 2+ hour ago  (822+ words) Artificial intelligence has become healthcare's favorite scapegoat, especially in insurance. Every denied claim, every delayed approval, every inexplicable "not medically necessary" response seems to get blamed on an algorithm in the background. Much of the frustration lands on prior authorization,…...

1+ week, 1+ day ago  (514+ words) In this context, infrastructure refers to the payment rails, enrollment flows, benefit wallets, and navigation platforms that sit between consumer spending authority and care delivery. From pooled purchasing to individual wallets These are not marginal trends. They reflect a structural…...

1+ week, 6+ day ago  (906+ words) AI can change that posture. Not because it replaces the people who safeguard clinical appropriateness, member fairness, and financial integrity, but because it can make payer operations fast enough, and insight-rich enough, to shift from after-the-fact processing to real-time partnership....

1+ week, 6+ day ago  (768+ words) The challenge for policymakers is balance: encouraging rigor without unintentionally weakening a program that now serves the majority of Medicare beneficiaries. Thoughtful rate calibration can determine whether this transition strengthens the program or strains it unnecessarily. None of those changes…...

2+ week, 2+ day ago  (812+ words) The Consolidated Appropriations Act of 2026 and the Department of Labor's proposed rule implement major PBM reforms for employers, but don't include everything they want, including a ban on spread pricing. For years, Congress has signaled that it wants to crack…...

2+ week, 2+ day ago  (329+ words) More brokers are introducing medical gap insurance, more employers are adopting it, and more employees are benefiting from the added protection. The next step is making sure awareness keeps pace with need. The rising cost of healthcare has become one…...

2+ week, 6+ day ago  (425+ words) Included Health is launching an alternative health plan centered on primary care, AI support, price transparency and easier navigation. Included Health, a navigation and virtual care company, is launching into the insurance space with its alternative plan design for employers,…...

3+ week, 3+ day ago  (652+ words) January has seen a slew of executive hires, promotions and layoffs across the healthcare industry. For instance, Aidoc, Suki and Particle Health named new executives. There were also layoffs at organizations including Takeda, Trinity Health and Horizon BCBS New Jersey....

3+ week, 5+ day ago  (478+ words) The 15 drugs selected for the Centers for Medicare and Medicaid Services drug price negotiation program accounted for about $27 billion in total prescription spending under Medicare Parts B and D. But this revenue from Medicare makes up a small percentage of each…...