Texas saw the largest increase in bronze ACA plan enrollment from 2025 to 2026, while West Virginia saw the largest decrease, according to CMS data analyzed by KFF. Bronze plan enrollment grew 26% nationally, from 7.3 million to 9.2 million,…
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The day after CMS released its final 2027 Medicare Advantage and Part D payment rule, Chris Klomp, director of Medicare and deputy administrator at the agency, sat down with Health Tech Nerds Radio podcast to walk through what changed, what…
CMS has issued operational guidance to states regarding how to implement H.R. 1’s Medicaid coverage restrictions for noncitizens, which take effect Oct. 1. On April 8, the agency outlined how states must update eligibility systems, applications, verification processes and claims…
Thirty-six percent of providers believe payers reliably deliver on promises, according to an inaugural Aetna provider survey released April 8. The survey will run quarterly, polling representatives of U.S. healthcare providers. This round fielded responses from 827 hospital system executives, physicians, nurses,…
AP of South Florida, a Florida-based insurance brokerage, has agreed to plead guilty to one count of major fraud against the U.S. for its role in a fraudulent ACA enrollment scheme. In a parallel civil resolution, AssuredPartners, a national brokerage…
Risk adjustment strategies built on retrospective chart chase are no longer just inefficient — they are increasingly financially exposed. As RADV audits expand and regulatory scrutiny intensifies, payer organizations are being forced to rethink not just how risk is captured,…
May 19, 2026 11:00 AM - 12:00 PM CDT
Presented by:
Presenters:
- John Murtha, Health Plan Executive, InterSystems
- Jonathan Masoudi, Chief Medical Officer, Clear Spring Healthcare
- Mark Dabney, Director, Risk Adjustment, Community Health Plan of Washington
- Lisa Purnell, Director, Risk Adjustment, Community Health Choice
Many payer-provider partnerships start with strong alignment but fail to deliver sustained results. In this webinar, leaders share what it takes to move from intent to execution — building trust, aligning operations and delivering consistent value across markets, provider types…
May 14, 2026 11:00 AM - 12:00 PM CDT
Presented by:
Presenters:
- Neil Kulkarni, VP Product Management – Provider & Clinical, Highmark
- Hussain Sheikh, VP Product Development & Management, enGen
- Gaurav Tiwari, Partner, Health Plans & Provider Practice, ZS
Imagine a patient asking an AI assistant to find the best hospital nearby — and your organization doesn’t appear. Not because of care quality, but because your digital reputation doesn’t reflect it. This session will give you a clear framework…
May 21, 2026 12:00 PM - 1:00 PM CDT
Presented by:
Presenters:
- Ayoka Pond, CMO at Baptist Memorial Health
- Kristi Melani, CMO at Reputation
- Carter Rees, VP of AI at Reputation
West Virginia and New Mexico are both launching Medigap “birthday rules” within the next year. Federal law does not include ongoing protections for beneficiaries who want to switch Medicare supplement coverage beyond the established one-time, six-month window. However, these state…
A federal judge in Minnesota denied the state’s motion challenging the federal government’s deferral of Medicaid funds, according to an April 6 opinion and order. The state filed a complaint against CMS, HHS and their respective leaders March 2. Earlier…