Payer

With a joint venture finalized, Reno, Nev.-based Renown Health and Oakland, Calif.-based Kaiser Permanente now co-own Renown’s health plan, Hometown Health.  For Kaiser, it marks its entry into Nevada. For Renown, it’s an opportunity to scale up its health plan…

Nearly one-third of physicians enrolled in Medicaid don’t treat patients covered by the program, according to a study published Feb. 2 in Health Affairs. A team led by researchers at Portland-based Oregon Health & Science University analyzed physician enrollment files…

CMS is planning to continue its Medicare Advantage audits and overpayment recoveries, according to a Jan. 27 memo. While federal estimates point to $17 billion in overpayments each year, the last major risk-adjustment data-validation recovery took place in payment year…

KLAS Research, a healthcare IT data and insights company, released its annual “Best in KLAS” report Feb. 4.    Best in KLAS, now in its 28th year, draws on tens of thousands of provider evaluations to identify the top-performing solutions in…

Optum has launched a pair of AI-driven prior authorization products, one designed to speed up submissions on the provider side and another to accelerate clinical reviews for payers. The provider-facing product, Digital Auth Complete, went live in January in collaboration…

Medicaid expansion campaign Florida Decides Healthcare relaunched efforts to collect signatures, now for the 2028 ballot, according to a Feb. 1 news release shared with Becker’s. The proposed amendment would boost Medicaid eligibility for those between ages 18 and 64…

Clever Care Health Plan ushered in almost 15,000 new Medicare Advantage members — membership growth of nearly 50% — during the 2026 Medicare annual enrollment period, according to a Feb. 3 news release from the company. Clever Care offers what…

Medicare Advantage insurers will likely continue to scale back supplemental benefits and exit certain markets if CMS finalizes its proposed 0.09% payment increase for 2027, according to a Jan. 30 analysis from Fitch Ratings. “Depending on finalized payment rate and…

As more hospitals and health systems grow frustrated with Medicare Advantage plans, Ascension is among the organizations rethinking how — and whether — to continue participating. Delays in care, high denial rates and growing administrative burdens are prompting tougher contract…

Preventive care significantly improves health outcomes—cancer screening alone has added as many as 16 million years to people’s collective lifespans. Yet only about 5% of adults receive the screenings recommended for their risk factors.   That isn’t a gap. It’s a chasm.  Preventive care detects serious illnesses early, when treatment is most effective. With 90% of the nation’s $4.5 trillion in annual health care…