3+ mon, 2+ week ago   (571+ words) CMS finalized a new rule aimed at streamlining the No Surprises Act’s overwhelmed arbitration system. Provider groups largely welcomed the reforms — though some industry leaders said additional changes are still needed to address alleged misuse and improve transparency. The Centers…...

3+ mon, 3+ week ago   (348+ words) Three health systems — Mount Sinai, Michigan Medicine and the University of Kansas Health System — are suing CVS Health, alleging its pharmacy benefit manager diverted roughly $250 million in savings from the 340B program through “spread pricing” between 2020 and 2025. Three health systems are…...

4+ mon, 2+ week ago   (547+ words) Ed Park is sincere and passionate about his calling as the CEO of Devoted Health, which provides Medicare Advantage plans to seniors in 29 states. But it remains to be seen if he can do more or the same with less....

4+ mon, 3+ week ago   (722+ words) A consultant who has analyzed healthcare policy over many decades declares that MA is in the middle of a fundamental reset both in terms of market headwinds and federal scrutiny. Especially at the Centers for Medicare and Medicaid Services, overpayments…...

8+ mon, 1+ week ago   (523+ words) Rising healthcare costs and flaws in the Medicare Advantage program are likely to dominate healthcare reform discussions in 2026, according to one PitchBook analyst. Potential policy changes could focus on improving affordability in the ACA market and fixing distorted incentives in…...

10+ mon, 1+ week ago   (200+ words) The 2025 Benefits Sentiment Index is based on a survey of 120 benefit consultants to self-insured employers and is sponsored by Quantum Health. The third annual edition of the 2025 Benefits Sentiment Index, a survey of 120 benefit consultants to self-insured employers, finds that…...

10+ mon, 3+ week ago   (565+ words) CMS Administrator Dr. Mehmet Oz said that Medicaid’s rapid spending growth is unsustainable and criticized state financing tactics that let providers and governments “game” the system for extra federal funds. He said CMS is shifting its fraud strategy to follow…...

1+ year, 1+ week ago   (398+ words) Out of the 476 ACOs that participated in the Medicare Shared Savings Program in 2024, 75% earned $4.1 billion in performance payments, CMS reported. Accountable care organizations (ACOs) in the Medicare Shared Savings Program saved $2.4 billion in 2024, according to data released last week by…...

11+ mon, 3+ week ago   (404+ words) We’re in the middle of a fundamental shift that’s giving consumers more power and choice over their health coverage while creating healthy competition in the marketplace. Consumer expectations are justifiably rising, and people want a much more pleasant, frictionless and…...