Cigna’s Express Scripts to transition away from rebate drug model

The massive PBM also said it will move to a cost-plus reimbursement model for in-network pharmacies. The moves come as the controversial drug middlemen attempt to lessen regulatory scrutiny.

High volume of surprise billing disputes are ineligible for arbitration, insurers allege

Plans found 39% of claims submitted to independent dispute resolution last year were actually ineligible for the process, but arbiters themselves caught only 17% of improper cases, according to AHIP and the BCBSA.

Top healthcare conferences to attend in 2026

These are the events healthcare leaders should plan for next year, covering topics like digital health, rural care and financial management.

CHS promises more hospital divestitures during Q3 earnings call

The Tennessee-based health system will continue to sell hospitals as it looks to focus more on capital-efficient outpatient care.

HCA raises 2025 guidance, but eyes looming headwinds

The for-profit operator's guidance raise is "cautious," one analyst said. Still, HCA is staring down challenges like the potential expiration of more generous Affordable Care Act subsidies.

5 minutes with Sutter Health’s CHRO

Learning and development has proven key to fighting burnout and ensuring the success of Sutter’s people managers, according to executive Deborah Yount.

CMS calls back furloughed employees to help with Medicare, ACA enrollment periods

Roughly 3,000 employees went back to work on Monday, funded by user fees as the shutdown drags into its fourth week.

Senators show bipartisan support for reforming 340B during HELP hearing

Lawmakers called for more transparency about how hospitals are using 340B revenue, including audits of participating facilities. 

Optum taps its second CFO in 6 months

It’s the latest management shakeup at UnitedHealth as the company attempts to shore up investor confidence.

Teladoc finance chief to step down

Mala Murthy, who has served as CFO of the telehealth company since 2019, will leave the position next month for an opportunity outside the healthcare industry.

Ballad Health sues UnitedHealth for Medicare Advantage ‘manipulation’

The Appalachian system said it is turning to the courts as a last resort after failing to resolve years of payment and patient care issues.

Molina slashes 2025 profit guidance again on ACA woes

Molina’s profit in the third quarter plummeted as the insurer was hit with an increase in marketplace medical costs that one analyst called “staggering.”

Health systems say AI is helping with care management, documentation burden

Executives from Houston Methodist, Risant Health, UPMC and Advocate Health took the stage at HLTH 2025 to discuss early results of their AI investments.

AHA urges tariff exceptions for certain PPE, medical devices

The American Hospital Association warned future tariffs arising from the Trump administration’s Section 232 investigation could disrupt access to an array of tools and personal protective equipment.

Top RFK aide lashes out against healthcare industry for profiting off of illness

Calley Means stopped short of accusing hospitals, insurers and drug companies of actively working to keep Americans sick, but said it was an "economic fact" that the companies benefit financially when people are ill.

‘A quiet alarm bell going off’: Job-based family coverage hits $27K annually

Premium increases are outpacing wage growth and general inflation at a time of intense focus on healthcare affordability, according to new research from KFF.

ANA President Jennifer Mensik Kennedy talks nursing shortage, vaccine misinformation

Federal divestment in nursing education and stress due to medical misinformation could add to the the nation's nursing shortage, according to the American Nurses Association leader.

Digital health IPO window opens, but uncertainty clouds outlook

Health technology firms are interested in going public next year, but policy and economic uncertainty is creating a difficult environment for IPOs, experts said at the HLTH conference last week.

Optum launches AI system to speed medical claims

Optum Real allows providers to receive information about patients’ health benefits in real time, the company said.

Elevance outperforms in third quarter but warns of Medicaid challenges

The Indianapolis-based company is the first major insurer to release earnings this cycle. Elevance did well in the quarter, but hinted that profits could be constrained in 2026.

Novo’s main shareholder pushes out more than half of company’s board

The Novo Foundation chair said the current board of the Wegovy maker, which is already dealing with layoffs and a CEO change, was too slow to react to obesity market shifts.

Advocate Health hopes new innovation center will boost medical research, training

The public-private partnership aims to pump money into medical research as federal funds dry up. "We're facing headwinds galore," said Advocate's chief innovation officer.

Highmark Health, Noom to launch weight management partnership in 2026

The partnership with Noom aims to cut costs by treating weight management as preventative healthcare. Nearly 2 million Highmark Health members are expected to be eligible for the programs.

Medical billing firm Cedar launches Medicaid enrollment tool as cuts loom

The tool, which aims to help patients enroll in and maintain coverage, comes as healthcare braces for major cuts to the safety-net insurance program.

Gen X and Millennials interested in health AI amid caregiving squeeze: survey

The two generations want to leverage new health technologies as they face cost worries and challenges caring for both aging parents and children, according to PwC.