Payer: Page
-
Yin Yang via Getty Images
DOJ launches strike force targeting West Coast healthcare fraud
The strike force allows the department's healthcare fraud unit to coordinate with U.S. attorney’s offices in Arizona, Nevada and the Northern District of California, where the DOJ says fraud schemes are increasing.
By Emily Olsen • May 4, 2026 -
Getty Images
How states are planning to implement Medicaid work requirements: survey
Most states are planning to adopt less restrictive policies to verify compliance with work requirements mandated by the “Big Beautiful Bill,” but some are implementing the policies early or checking eligibility more frequently.
By Emily Olsen • May 4, 2026 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/provider relationships
As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
Getty Images
Sponsored by PointClickCareWhat’s next for post-acute care: Data, collaboration and the path forward
Post-acute care is moving to the center of payer strategy. Here’s why it matters.
By PointClickCare • May 4, 2026 -
Retrieved from Carol M. Highsmith.
Nebraska rolls out Medicaid work requirements, putting tens of thousands at risk of coverage losses
The Cornhusker State is the first to roll out work requirements under the GOP’s “Big Beautiful Bill,” well in advance of the law’s 2027 deadline. Between 20,000 and 40,000 people are expected to lose Medicaid as a result.
By Rebecca Pifer Parduhn • May 1, 2026 -
Alamy
Cigna exits ACA exchanges despite dramatic profit growth in Q1
The insurer plans to say goodbye to the ACA exchanges after this year, and is exploring a potential sale of its controversial claims review subsidiary. Both businesses were more trouble than they were worth, executives said.
By Rebecca Pifer Parduhn • April 30, 2026 -
Getty Images
Health disparities persist across states and may widen further with federal cuts: report
Native, Hispanic and Black communities experienced worse health access and affordability issues than white people in most states, according to a new report from the Commonwealth Fund.
By Sydney Halleman • April 29, 2026 -
Neiu20001 via Getty Images
Profit recovery is ‘priority No. 1,’ Humana promises
Humana’s foremost priority is returning to 3% Medicare Advantage margins in 2028, CEO Jim Rechtin repeatedly promised investors on Wednesday morning. Still, the insurer’s profits dipped in the first quarter.
By Rebecca Pifer Parduhn • April 29, 2026 -
Samantha Liss/Healthcare Dive
Centene hikes 2026 profit guidance after buoyant Q1
The insurer, a mainstay in government programs like Medicaid and the ACA exchanges that have been wracked by higher spending, successfully controlled costs in the quarter, leading to $1.5 billion in profit.
By Rebecca Pifer Parduhn • April 28, 2026 -
Getty Images
Insurers making progress on standardizing prior authorizations
Aligning electronic data submission requirements for prior authorizations is one prong of the insurance industry’s commitment to reform the unpopular preapprovals.
By Rebecca Pifer Parduhn • April 27, 2026 -
elements.envato.com/iLixe48
Sponsored by ParadigmWhy health plans are missing one of their most costly care categories
The overlooked surgery category quietly driving utilization and cost for health plans
By Cathy Hartman, Chief Healthcare Solutions Officer, Paradigm • April 27, 2026 -
Andrew Harnik/Getty Images via Getty Images
Medicare AI prior authorization pilot delaying care in Washington: report
The report compiled by Sen. Maria Cantwell, D-Wash., found procedures in the state that were previously approved in two weeks now take four to eight weeks to be authorized.
By Emily Olsen • Updated April 27, 2026 -
Alamy
Molina controls costs in Q1 but future Medicaid spending in doubt
The insurer beat analyst expectations for adjusted earnings in the first quarter. But steeper Medicaid membership losses than expected could saddle Molina with higher costs down the line.
By Rebecca Pifer Parduhn • April 23, 2026 -
Kayla Bartkowski via Getty Images
CMS, FDA unveil speedier Medicare coverage pathway for breakthrough devices
The pathway is designed to reduce the delay between FDA authorization and Medicare coverage for certain Class II and Class III breakthrough medical devices.
By Ricky Zipp • April 23, 2026 -
Scott Olson via Getty Images
CFOs feel healthcare pain rising as GLP-1s stretch budgets: Mercer
Average healthcare costs for U.S. employers are expected to rise 6.7% this year, hitting a 15-year high.
By Alexei Alexis • April 22, 2026 -
Getty Images
Prices rose after No Surprises arbitration for some care: analysis
The data compiled by the Brookings Center on Health Policy shows that average arbitration prices for some services like imaging were seven times higher than Medicare prices.
By Sydney Halleman • April 22, 2026 -
Permission granted by Elevance Health
Elevance perks up in 2026 though Medicare Advantage payout could ding profits
The Indianapolis-based insurer raised its 2026 earnings guidance after posting a better first quarter than Wall Street expected. Still, Elevance lodged a $935 million expense to cover what it might owe the CMS over faulty data reporting.
By Rebecca Pifer Parduhn • Updated April 22, 2026 -
Courtesy of UnitedHealth Group
UnitedHealth hikes profit outlook after better-than-expected first quarter
Premium hikes, plan redesigns and other efforts from the Minnesota-based company to wrangle medical spending bore fruit in the first quarter. UnitedHealth’s stock jumped accordingly.
By Rebecca Pifer Parduhn • April 21, 2026 -
Courtesy of Blue Shield of California
Blue Shield of California taps chief pharmacy officer
Hayley Park will oversee BSCA’s prescription drug programs. The insurer has worked to overhaul its pharmacy management model in a bid to lower drug costs.
By Emily Olsen • April 21, 2026 -
Judge dismisses Aetna’s No Surprises fraud suit against Radiology Partners
The insurer accused the radiology group of gaming the No Surprises Act to reap higher reimbursement. A judge tossed the case last week, saying Aetna needed to raise its complaints during the dispute resolution process.
By Emily Olsen • April 20, 2026 -
Counsel Health via Google Gemini
Sponsored by Counsel Health3 questions every payer should ask about medical AI
As medical AI scales, how are payers ensuring safe and compliant care?
April 20, 2026 -
Anna Moneymaker via Getty Images
Stakeholders urge Labor Department to finalize PBM transparency rule
Employers, lawmakers and more said regulators should hustle to get disclosure mandates for the controversial drug middlemen across the finish line, while PBMs slammed the rule as illegal, unnecessary and anticompetitive.
By Rebecca Pifer Parduhn • April 17, 2026 -
Getty Images
More employers considering medical, pharmacy vendor switch amid rising healthcare costs, survey finds
Healthcare affordability continues to keep employers up at night. More businesses are shopping for new healthcare vendors as a result, according to the Purchaser Business Group on Health.
By Rebecca Pifer Parduhn • April 16, 2026 -
Joe Raedle via Getty Images
ACA exchanges will continue to shrink as fewer enrollees pay premiums, analysis suggests
About 14% of ACA enrollees didn’t pay premiums in January, a higher rate than usual and one that suggests ACA enrollment will continue to decline, according to Wakely.
By Rebecca Pifer Parduhn • April 16, 2026 -
Getty Images
More insurance claims denials are being overturned upon appeal, study finds
Study authors, who reviewed data from New York, said rising rates of overturned claims suggest that insurers’ claims review processes might not be working as intended, and policymakers should consider getting involved.
By Rebecca Pifer Parduhn • April 15, 2026 -
Getty Images
CMS accepts more than 150 providers, digital health firms for ACCESS model
Participants will receive set reimbursement for managing Medicare beneficiaries’ chronic conditions, like diabetes, chronic kidney disease and hypertension.
By Emily Olsen • April 14, 2026
Previous
