How the DOJ Is Tackling Fraud in the ACA Marketplace
At the Medicarians Conference, Ricardo Carcas, assistant special agent in charge of the Office of Investigations, discussed cases of fraud in the ACA and how the DOJ is combatting it.
Oscar Health Seeks to Build ‘Airbnb for Healthcare’ with New Marketplace, CEO Says
Oscar Health launched Lucie, a marketplace aimed at making healthcare more shoppable.
The Hidden Administrative Tasks Draining Small Practices
Small practices play a critical role in healthcare delivery, but they cannot continue to absorb ever-increasing administrative demands without consequences.
UnitedHealthcare Expands Rural Healthcare Initiatives, Reduces Prior Auth Requirements
UnitedHealthcare is exempting rural providers from most prior authorization requirements.
Expanding the CJR Model Is a Logical Step in VBC, but Implementation Challenges Remain
CMS is proposing to make its joint replacement bundled payment model mandatory nationwide. Experts say it is a logical step, but warn that mandatory participation could be challenging for hospitals to implement.
Behavioral Health Demand Has Increased by 62% Since 2018. What the Industry Needs to Know
A new report from Trilliant Health finds behavioral health demand has surged since 2018, but workforce shortages and access barriers continue to limit care.
Wisp, Visby Partner to Expand Access to At-Home STI Test
Wisp partnered with Visby Medical to expand access to Visby’s at-home sexually transmitted infection test and provide follow-up treatment through Wisp’s telehealth platform.
Beyond Analytics: How Sellers Dorsey is Hard-Coding Value into Medicaid Policy [Video]
How to turn analytics into actual policy outcomes.
New Bill Seeks to Lower Out-of-Pocket Drug Costs
Rep. Greg Murphy introduced a bill that would require out-of-pocket prescription drug spending to count toward patients’ deductibles and out-of-pocket maximums regardless of where the drugs are purchased.
Vida Health Teams Up with ŌURA to Provide More Personalized Metabolic Care
Vida Health is partnering with ŌURA to use data from the Oura Ring to provide more continuous, personalized cardiometabolic care and improve patient outcomes.
Report: Growth in MA Is Associated With Lower Total Medicare Spending
New research from the Elevance Health Public Policy Institute finds that higher enrollment in Medicare Advantage may be linked to lower overall Medicare spending.
‘A Significant Assault on Our Health’: Healthcare Policy Leaders Condemn Trump’s Budget Proposal
President Donald Trump’s 2027 budget proposes deep healthcare cuts, raising concerns about harm to patients and research.
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Survey on the Healthcare Financial Landscape Offers a Roadmap for Stakeholders
Zelis highlights how employers, payers, and consumers are integrating digital tools to manage healthcare costs.
With $100M Raise, Chapter Targets Medicare Mismatches for Seniors
Chapter’s Series E round was led by Generation Investment Management, with participation from Fifth Down Capital, 8VC, Stripes, XYZ Venture Capital, Addition, Narya Capital, Susa Ventures and Maverick Ventures.
Which Health Plans Rank Highest In Digital Experience?
Cigna Healthcare ranks highest in digital experience among commercial plans, while UPMC Health Plan ranks highest among Medicare Advantage plans, according to a new JD Power report.
Insurers have Cut Prior Auth by 11% Following Commitments
Health insurers have reduced prior authorizations by 11% and are continuing reforms to streamline and speed up approvals, according to an announcement from AHIP and Blue Cross Blue Shield Association.
TPA Yuzu Health Aims to Revamp Health Benefits with $35M Boost
Yuzu’s $35 million round was led by General Catalyst and Chemistry, with participation from Anthropic’s Anthology Fund, Bain Future Back Ventures, Timeless Ventures, Lachy Groom and Neo.
The Women’s Health Market Is Poised to Reach $600B by 2030. That’s if ‘We Do Nothing’
A PwC report finds that women’s health is evolving into a much larger, high-growth market as investment expands beyond reproductive care, though it remains underfunded and under-researched.