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Hospitals affiliated with Nashville, Tenn.-based HCA Healthcare have sued multiple insurers over alleged claim denials and reimbursement issues in 2025…
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Health insurers are using AI to speed up prior authorization, but Fitch expects regulators to keep requiring humans in the loop when care is denied, and that will limit how much efficiency payers can gain. The outlook comes from Fitch’s…
Charlotte, N.C.-based Atrium Health launched a program to lower out-of-pocket costs for North Carolina State Health Plan members who use its physicians and hospitals, but State Treasurer Brad Briner warned the program could bankrupt the plan, North Carolina Health News…
Ask a health plan executive what they want AI to do, and they’ll usually answer with a goal, faster credentialing, cleaner directories, fewer complaints. But AI isn’t the goal. It’s one way to get there, and for most of what…
Presented by:
- Chris Lance, Chief Product Officer, Quest Analytics®
- Adam Sullivan, VP of AI, Change Healthcare, Labcorp
Minneapolis-based Fairview Health Services filed a lawsuit Oct. 1 against UnitedHealthcare, alleging false advertising with the insurer’s 2027 Medicare Advantage plans. The complaint, filed in Minnesota federal court, said Fairview decided in June to not renew its contract with UnitedHealthcare’s…
A federal judge has largely rejected Alignment Healthcare’s bid to throw out a former senior executive’s whistleblower lawsuit that accuses the Medicare Advantage insurer of financial mismanagement. Alignment’s former chief technology officer, Hakan Kardes, PhD, alleged in July that he…
There will be at least six new carriers on ACA marketplaces in 2027, despite the continued pressures facing the wider market. Nationally, insurers have proposed a median 14% rate increase for 2027, the second straight year of double digit hikes.…
By the time MLR pressure shows up in your numbers, the margin may already be locked into the quarter. The question is whether you’ll spot the signals early enough to change the outcome. Most health plans don’t recognize margin pressure…
Presented by:
- Stewart Hinrichsen, Senior Director, Value-Based Strategy, Martin's Point
- Raj Lakhanpal, Chief Executive Officer, SpectraMedix
- Sean Kelly, Senior Vice President, Growth and Business Development, SpectraMedix
- Charles Chervitz, Consultant, SpectraMedix
SCAN Health Plan and Sacramento, Calif.-based Sutter Health are bringing their co-branded Medicare Advantage plans to four more Northern California counties in 2027, up from six in 2026. SCAN and Sutter first announced their collaboration in 2025, with Sutter hinting…
Twelve insurers have announced they will stop offering individual ACA marketplace plans, either nationally or in specific states, after the 2026 plan year. The withdrawals come amid declining enrollment nationwide, rising premiums and the expiration of enhanced premium tax credits…
Molina Healthcare took over the contract for a specialized Florida Medicaid and CHIP plan, previously managed by Centene’s Sunshine Health, on Oct. 1. Molina first announced it had secured the contract in November 2025, but the start date had not…
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From Spreadsheets to Smart Systems: AI-Driven Visibility for the Procedural Patient Journey
Presenter: Mauricio Garcia Jacques, MD, MPH, Raport Inc
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