The Latest

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  ICHRAs, a growth opportunity for insurers, face uphill battle

  Employers are turning to Individual Coverage Health Reimbursement Arrangements to cut costs, but rising premiums and instability on the individual market pose challenges.

  Payer

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  Sponsored by SKYGEN

  Looking beyond fragmentation: How centralization can fix dental provider data

  Explore how centralizing dental credentialing and directories reduces fragmentation, risk and costs.

  Health IT

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  Deep Dive

  One year after HHS layoffs, a department in disarray

  Thousands of employees of the Department of Health and Human Services were fired last spring. Their colleagues are still picking up the pieces.

  Government

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  CMS finalizes higher Medicare Advantage rates for 2027 in gift to insurers

  Regulators locked in a 2.48% rate hike for next year, much higher than the 0.09% that was proposed. Analysts said the Trump administration was likely spooked about coverage disruptions for seniors before the midterm elections.

  Payer

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  Deep Dive

  CMS tackles big policy changes with diminished workforce

  The agency is embarking on major initiatives — including helping states implement Medicaid work requirements — with fewer workers in the wake of the federal government’s restructuring, experts say.

  Government

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  Insurers committed to cutting prior authorizations have eliminated 11% so far

  Last summer, major payers committed to pare back onerous prior authorization policies, to the skepticism of providers. Now, AHIP and the Blue Cross Blue Shield Association are providing an update on insurers’ progress.

  Payer

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  Veradigm names CFO as it works to get current on financial filings

  Christian Greyenbuhl will replace Lee Westerfield, who has been interim CFO since 2023. The health IT company has worked to get up to date on its financial reporting requirements after it was delisted from the Nasdaq in 2024.

  Health IT

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  Hims & Hers says limited data stolen in social engineering attack

  The telehealth provider said hackers gained access to a third-party customer service platform, but medical records remained secure.

  Health IT

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  Centene creates two new executive leadership roles

  It’s the latest in a flurry of executive appointments from health insurers looking to strengthen their leadership teams amid regulatory headwinds and elevated medical costs.

  Payer

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  White House seeks 12% cut to HHS in 2027

  The Trump administration is requesting about $111 billion in discretionary funding for the HHS, nearly $16 billion less than its budget in 2026.

  Government

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  CMS finalizes Medicare Advantage star ratings overhaul, sending billions of dollars more to insurers

  Regulators cut almost a dozen metrics that factor into the quality ratings and reverted back to an older and more generous bonus system. MA plans will get more than $18 billion in additional payments over the next decade as a result.

  Payer

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  FTC urges Tennessee to preserve Ballad Health’s COPA

  Lawmakers are considering bills that would unwind the state’s oversight over Ballad, a large state-sanctioned hospital monopoly. The FTC argues that’s a bad idea.

  Hospitals

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  AI scribe adoption linked to modest reductions in EHR, documentation time: study

  Clinicians’ use of an AI scribe was associated with 13 fewer minutes each day inside electronic health records and 16 fewer minutes on documenting patient care, according to the research published in JAMA.

  Health IT

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  CHS closes sale of Alabama hospital

  Community Health Systems completed the divestiture of Crestwood Medical Center this week as the for-profit operator continues paying down its debt.

  Hospitals

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  Elevance sidesteps Medicare Advantage sanctions for now

  The insurer had until the end of March to correct faulty data submissions or be hit with severe sanctions from the CMS. But regulators agreed to give Elevance more time to comply.

  Payer

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  Over 130 hospitals sue HHS over DSH payments

  Hospitals in 16 states have sued the department, arguing a 2023 final rule underpays hospitals that treat a disproportionate number of low-income patients.

  Hospitals

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  Bipartisan lawmakers urge CMS to crack down on Medicare Advantage overpayments

  Senators praised a recent CMS proposal aimed at reducing payments in MA, but urged the agency to work with Congress and go further.

  Payer

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  Elevance fills slew of mid-level leadership positions

  The company has been overhauling its executive bench as it attempts to bolster flagging insurance profits and capitalize on growth in Carelon, including through six new appointments on Tuesday.

  Payer

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  HHS reverses Biden-era tech reorganization, returns ONC name

  The Trump administration said the revamp, which reverses the HHS’ 2024 restructuring of its technology functions, will better coordinate AI, data and cybersecurity policy across the department.

  Health IT

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  Lilly’s AI commitment expands through deal with Insilico

  Eli Lilly is expanding its commitment to artificial intelligence-driven drug development, signing a deal with Hong Kong-based Insilico to develop and commercialize experimental drugs in preclinical development.

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  ACA premium spike funnels more consumers into high-deductible plans: CMS

  Average premiums for ACA plans increased 58% this year after more generous financial assistance expired, while enrollment in low-premium, high-deductible bronze plans jumped, according to new federal data.

  Payer

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  Tech nonprofit sues CMS over Medicare AI prior authorization pilot

  The Electronic Frontier Foundation is seeking more information on the government’s agreements with participating vendors, along with records related to any evaluations on accuracy, bias or hallucinations in their technology.

  Payer

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  Duke Health names familiar face as new CEO

  David Zaas will return to Duke Health as chief executive in May. Zaas served in various leadership roles at the health system for almost two decades.

  Hospitals

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  Opinion

  Restoring balance to the No Surprises Act

  In response to an opinion piece from the American Hospital Association, Dr. Catherine Gaffigan, president of health solutions at Elevance, defends the company’s new facility administrative policy.

  Hospitals

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  Justice Department sues NewYork-Presbyterian in second hospital antitrust case this year

  Federal regulators accused the health system of using its market power to force insurers into “all-or-nothing” contracts. The Justice Department filed a similar lawsuit against OhioHealth in February.

  Hospitals

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  Stryker restores most manufacturing after cyberattack

  The medtech company has been working to restore manufacturing, ordering and shipping operations since it was hit by a cyberattack on March 11.

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