News
What Happens to Independent Medicine When Private Equity Shows Up With a Checkbook
4+ day, 1+ hour ago (568+ words) The entry story has been told. Goldman Sachs and Charlesbank hold MDVIP. Revelstoke holds a concierge platform. Frontier is building employer-facing DPC infrastructure. Marathon Health and Premise Health are scaling the advanced primary care model for large employers. The capital…...
How Fairview Health Services Turned Around a $315M Loss
5+ day, 10+ hour ago (276+ words) Fairview Health Services turned a $315 million annual loss into a nearly $600 million turnaround in just two years. At the AHA Leadership Summit, CEO James Hereford broke down the strategy behind the comeback, from workforce redesign to frontline-driven process fixes. In…...
Why Most Healthcare Brand Strategies Fail the First Time Leadership Gets Tested
1+ week, 3+ day ago (699+ words) A few years ago, I watched a regional nonprofit in community health and wellness come close to imploding. An executive director was let go over financial concerns. Several of her closest donor relationships walked out with her. The CEO scrambled…...
ACA Marketplace Insurers Propose 14% Median Premium Increase in 2027
1+ week, 3+ day ago (393+ words) KFF found that ACA Marketplace insurers are proposing a median 14% premium increase for 2027, driven by rising healthcare costs and the expiration of enhanced premium tax credits. Affordable Care Act Marketplace insurers are proposing a median premium increase of 14% in 2027, according…...
Pearl Health Lands $110M to Support Value-Based Care for Medicare Patients
1+ week, 4+ day ago (237+ words) Pearl's $110 million raise includes a $50 million equity investment led by Andreessen Horowitz with participation from Viking Global Investors, AlleyCorp and Ulysses Capital, as well as a $60 million debt facility led by Trinity Capital. Pearl Health, a healthcare technology company helping…...
Elevance Sues CMS Over Star Ratings, Seeks Same Recalculation Applied to Clover
1+ week, 5+ day ago (277+ words) The star ratings battle continues, this time with Elevance Health. Elevance filed a lawsuit last week against the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, alleging that CMS unlawfully refused to recalculate Elevance’s 2026 Medicare…...
The AI Playbook for Health Plans: 5 Steps for Leaders Who Don’t Know Where to Start
2+ week, 2+ hour ago (788+ words) I’ve had the privilege of speaking with health plan executives across the country, and here’s what I keep hearing: everyone wants to talk about AI, but almost no one knows where to start. One leader put it perfectly when she…...
Why the Office of Personnel Management Needs Access to Government Employee Health Plan Claims Data
2+ week, 4+ day ago (340+ words) Without knowledge of the exact amount providers billed and middlemen charged in fees, OPM can’t fix payment discrepancies. The Office of Personnel Management recently made headlines by requesting health claims data for workers covered under the Federal Employees Health Benefits…...
How Payers Can Use AI to Improve the Healthcare Financial Experience
2+ week, 6+ day ago (700+ words) Zelis CEO Amanda Eisel discussed how AI can create value when it is applied to measurable outcomes: simplifying claims workflows, reducing administrative burden, strengthening payment integrity, improving the payments experience, and empowering members to navigate their healthcare financial journey with…...
CMS Recalculates Star Ratings — Again
3+ week, 20+ hour ago (580+ words) CMS is recalculating some 2026 Medicare Advantage Star Ratings after a court ruled it improperly calculated Clover Health's rating, a decision that could boost payments for a small number of insurers. The flux around CMS Star Ratings continues. Conflict between CMS…...