Mass General Brigham Health Plan is launching a new Value HMO product for large employers on Jan. 1. The HMO uses a high-value provider network, rather than a broader network. The HMO includes access to hospitals and affiliated providers under…
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Kaiser Permanente led the 2027 U.S. News & World Report ratings for the “best overall” Medicare Advantage companies. The ratings, published Oct. 14, are based on a five-point scale, assigning weights to more than 30 CMS quality measures. After calculating…
The IRS and Treasury Department have proposed regulations, published Oct. 15, to implement HR 1 provisions and reform premium tax credits for ACA exchanges. “The proposed rules protect eligible taxpayers while strengthening the integrity of the premium tax credit,” IRS…
CMS has reinstated a small number of enrollees who lost coverage after the agency canceled ACA policies for more than 760,000 people, according to a KFF Health News report published Oct. 15 in NPR. KFF Health News learned of the…
For years, payers have built their data strategies largely around claims, a valuable source of information about cost, utilization and patient activity. But claims alone provide only part of the picture. Bringing clinical data into the equation can give payers…
From a Maryland CEO indicted in connection with more than $100 million in at-home COVID-19 test billing, to an Arizona addiction treatment clinic owner sentenced to 14 years in prison for a $69 million Medicaid fraud scheme, here are 10…
One Platform, Not Five Vendors: How Growing Health Plans Are Consolidating Payer Technology
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Most health plans did not set out to build a patchwork of vendors. It happened one urgent need at a time: a risk adjustment tool here, a quality reporting platform there, a separate chart retrieval vendor, and yet another system…
CMS released 2027 Medicare Advantage star ratings on Oct. 8, giving more insight into the MA landscape beyond health plans’ marketing materials. Contracts receive a rating each year, ranging from one to five stars. The ratings help beneficiaries compare plans,…
Cigna is facing a lawsuit claiming it made a profit by underpaying out-of-network ground ambulances, according to a class-action complaint filed Oct. 12 in a California federal court. The lawsuit centers on self-funded employer health plans that Cigna administers under…
Healthcare has a peculiar talent for embracing operational innovation in principle while resisting the very changes required to achieve it. Too often, the fear of messing up (FOMU) wins out over the fear of missing out (FOMO), signaling that your…
Nov 18, 2026 3:00 PM - 4:00 PM CST
Presented by:
Presenters:
- Aled Miles, OBE, CEO, Intellistack and the Welsh Government Envoy to the United States
- Sarah Galyon, Senior Industry Practice Director, Intellistack