This disconnect has become one of the defining operational challenges facing Medicaid plans. What was once considered an under-the-radar risk is no longer subtle. It is now actively shaping plan performance, provider behavior, and financial outcomes across Medicaid systems.
Hospitals have an opportunity to make strategic changes now that can better position both their organizations and their patients for what’s ahead. Here’s what to expect and where to focus next.
In a recent interview, Esperion president and CEO, Sheldon Koenig talks about the reality of statin intolerance and his company’s expansion into new diseases
Upended by chronic diseases and community realities, healthcare needs to shift its priorities to post-acute environments.
There is no question the pressures are heavy, but there is also an opportunity for organizations to rethink how they deliver care, how they support the people they serve, and how they invest limited resources.
Digital health M&A, 340B challenges and federal funding cuts are top healthcare trends to watch in 2026, according to LRVHealth.
Healthcare’s next frontier isn’t policy reform or payment reform. It’s experience reform — reimagining every touchpoint between members, providers, and plans through the lens of design and empathy.
Across the nation, state-based health insurance exchanges are searching for ways to better serve their communities while making enrollment easier, more personal, and more accessible for everyone.
Pyx Health launched an AI-driven platform to help members navigate care, meet new Medicaid and SNAP requirements and address social needs like food insecurity.
Time is of the essence, particularly for those with cognitive conditions. The loss of telehealth flexibilities, combined with disruptions to Medicaid, could have devastating consequences for millions of patients with dementia and other cognitive and behavioral conditions.
Ideas floated by the Trump Administration and Democrats in Congress aim to expand access to fertility treatment as an essential health benefit. But an influx of patients could collide with an already-brittle system of 430,000 annual cycles, 5,000 embryologists, and long-overdue lab upgrades.
Newly launched Pfizer drugs will be priced at parity to prices in comparable developed nations, according to the most-favored nation pricing agreement. But industry observers note that big pharma companies are also raising some prices overseas as part of a strategy to protect U.S. revenue.
Greenway Health blends smart technology with human expertise to elevate revenue cycle.
Pluto Health is now working with Medicare, Medicaid and commercial plans like UnitedHealthcare, Aetna, Blue Cross Blue Shield, Ambetter and Cigna.
The coming changes in Medicaid will place health plans squarely between a rock and a hard place. Here's how plans are bracing for change.
If we gut school-based care, we’re not only closing doors, we’re also deepening the racial and economic inequities that already shape our mental health system. We can’t claim to care about equity in healthcare if we’re willing to strip care from the very places that reach the kids who need it most.
Discover the top-rated Medicaid planning lawyers who help families protect assets, provide quality care and navigate elder law with confidence.
Here's a roadmap that brings together a wide range of existing and new initiatives under four key goals that enable community-based organizations to take stock of their existing capabilities and coordinate across them effectively.