Health plans have rapidly embraced AI for multiple use cases and leaders are focused on creating measurable performance improvement and achieving front-line buy-in. To learn more about how health plans are leveraging AI to improve payment integrity and performance, Becker’s…
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Hospital leaders are getting long-awaited clarity from Congress this week as lawmakers unveil a bipartisan healthcare deal tied to a broader government funding package. The 771-page proposal includes major wins for providers, including a multiyear delay of Medicaid DSH cuts,…
Founded in 2023, Texicare — a Texas Mutual affiliate — offers health coverage to small businesses throughout the state. Texicare President and CEO Meredith Duncan previously worked at Aetna, Bright Health and Kaiser Permanente. She spoke with Becker’s about the…
CMS estimated there were $28.83 billion in improper payments for Medicare fee for service in fiscal 2025. Compared to 2024 reporting, that value is down from $31.7 billion. “While CMS’ improper payment reporting programs are designed to protect the integrity…
Bloomington, Minn.-based HealthPartners launched its copay-only health plan, Simplica NextGen Copay, this year. The plan sets prices for in-network care without a deductible or coinsurance. Moe Suleiman, senior vice president of commercial business, and Maggie Helms, senior vice president, chief…
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New Mexico has seen the biggest increase in ACA enrollment from 2025 to 2026, while North Carolina has seen the largest decrease, according to KFF. The ranking below uses preliminary CMS data comparing similar periods during the 2025 and 2026…
Alignment Healthcare has California roots, but its CEO, John Kao, is confident about planting seeds for growth elsewhere. Mr. Kao weighed in on Alignment’s strategy Jan. 14 during the J.P. Morgan 2026 Healthcare Conference in San Francisco. Just days before,…
The ACA open enrollment period for 2026 ended Jan. 15, as a tumultuous battle over enhanced subsidies continues. The possible return of subsidies may no longer mean much for this year. Here are six things to know about how the…
Blue Cross Blue Shield of Vermont backed a campaign, called Vermont Affordable Care, focused on comparing pricing policies at independent facilities and academic centers. The initiative — also led by St. Albans, Vt.-based Northwestern Medical Center, Colchester, Vt.-based Green Mountain…
Oakland, Calif.-based Kaiser Permanente has agreed to pay $556 million to resolve allegations that it violated the False Claims Act by submitting invalid diagnosis codes for Medicare Advantage enrollees to obtain higher payments from the federal government. According to the…