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Health system executives are under growing pressure to manage tighter margins, navigate shifting reimbursement models and cultivate strong payer relationships.…
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Health system executives are under growing pressure to manage tighter margins, navigate shifting reimbursement models and cultivate strong payer relationships. At the same time, unprecedented volumes of pricing data are becoming available, offering health systems a new source of insight…
The gap in out-of-pocket spending between Medicare Advantage and fee-for-service beneficiaries is widening, according to a report from the Better Medicare Alliance. The pro-Medicare Advantage group, backed by major insurers, commissioned the analysis, which was conducted by ATI Advisory. The…
Payers have faced state penalties in 2025 for slow reimbursements, improper claims denials, and mental health parity violations. Fines in 2024 are here. Payers fined by states in 2025:
Walmart has partnered with Soda Health to launch the Walmart Everyday Health Signals program, aimed at helping Medicare Advantage and Medicaid enrollees make healthier food choices through personalized guidance based on online shopping patterns. Members will receive tailored insights on…
Preparing for regulatory changes, investing in AI and technology and improving member experiences are among the top priorities for payer executives in the second half of 2025. Becker’s checked in with 15 payer leaders to learn what tops their to-do…
Many insurers are asking for double-digit rate increases in 2026 for the individual and small group exchange markets as they face a potential expiration of enhanced premium tax credits and rising costs.
A federal judge has approved a $69 million agreement to settle a class-action lawsuit that alleged UnitedHealth Group prioritized its business relationship with Wells Fargo over concerns that its 401(k) plan contained low-performing target-date funds, according to court records. Judge…
A former Medicare Advantage executive has been found not guilty of healthcare fraud. A jury found Kenia Valle Boza, the former director of Medicare risk adjustment analytics for HealthSun Health Plans, not guilty of one count of conspiracy to commit…
A group of Democratic lawmakers has introduced legislation to create a public insurance option for individuals and employers. The Choose Medicare Act was introduced by Reps. Jimmy Gonzalez, Jared Huffman, LaMonica McIver and Eleanor Holmes Norton, and Sens. Jeff Merkley…
Fitch Ratings has downgraded the health insurance industry’s outlook to deteriorating from neutral because of rising utilization and Medicaid and ACA cuts proposed in Republicans’ One Big Beautiful Bill Act. The bill was passed by the House of Representatives on…