NEWS

The federal government has been paying billions more for Medicare Advantage enrollees than it would under traditional Medicare, but tighter rules are starting to close the payment gap. Key Takeaways Payment gap narrows— The federal government is projected to pay 14% more for Medicare Advantage enrollees in 2026 than it would under traditional fee-for-service Medicare, down from 20% in 2025. $76 billion still at stake— Despite meaningful progress, the overpayment gap still amo

When courts become the last line of defense for public health funding, the insurance industry should pay close attention. Key Takeaways A federal judge blocked the cuts —A U.S. District Court judge issued a preliminary injunction stopping the Trump administration from eliminating more than $600 million in Centers for Disease Control and Prevention (CDC) health grants to Illinois, California, Colorado, and Minnesota. Chronic disease prevention —Funding at risk covers HIV preve

Health care revenue doesn't slow in a vacuum. When the numbers shift, they carry consequences for every player in the ecosystem, from the insurers setting premium rates, to the agents advising plan selection, and the marketers trying to reach newly vulnerable populations before competitors do. The 2025 data is in, and the picture it paints calls for clear-eyed strategy.

Microsoft just gave millions of people an AI-powered health advisor that reads their medical records, tracks their vitals, and helps them show up to the doctor's office ready to ask the right questions.

Here's a staggering number: 80% of inpatient hospital admissions now involve patients with at least one chronic condition. More than half of Medicare beneficiaries between ages 65 and 74 already live with at least one chronic condition. Among those 75 and older, that share climbs to nearly two thirds. And over the next decade, the population aged 75 and older is projected to grow 44% while most other age cohorts will grow less than 10% or might even shrink.

After years of financial turbulence, large health systems are finding their footing again. Higher patient volumes, smarter cost management, and robust investment returns combined to strengthen margins across the nonprofit sector in 2025. Many systems that were barely breaking even two years ago are now reporting operating margins in the 5% to 6% range.

The federal government is making an unprecedented bet on rural health care. Through the RHT program, the U.S. Centers for Medicare and Medicaid Services (CMS) has committed $50 billion over five years, with $10 billion allocated annually beginning in fiscal year 2026. Each state received an average first-year award of $200 million, with totals ranging from $147 million to $281 million, depending on rural population size and health system need.

The federal government has a new investigative partner, and it never sleeps. Key Takeaways Record recoveries —The DOJ recovered more than $6.8 billion through False Claims Act (FCA) settlements and judgments in fiscal year 2025, the highest annual total in the statute's history. AI is now a core enforcement tool —Federal prosecutors used artificial intelligence in 315 cases in 2025, a 31% increase from the prior year, enabling investigators to identify billing anomalies at un

Is the government accidentally helping criminals? The country's biggest Medicaid carrier thinks so, and they’ve just issued a high-stakes demand for a regulatory overhaul. Key Takeaways Centene's seven-point reform push —The Medicaid market leader sent the U.S. Centers for Medicare and Medicaid Services (CMS) a formal letter urging the agency to overhaul what it calls a "complex web of regulations" that slow fraud investigations. Payment suspension delays are a core complaint

What if the biggest breakthrough in prior authorization isn't a single piece of technology, but the collaboration behind it? Key Takeaways Ambient AI is evolving —The same technology that transformed clinical documentation is now being deployed to tackle the notoriously slow and burdensome prior authorization process. Partnerships are essential —Leading AI companies aren't going it alone; they're forming strategic alliances with payers, providers, and health information netwo

While the broader Medicare Advantage market stumbles, a quieter revolution is reshaping how America's most vulnerable seniors get their coverage. Smart insurers are racing to get ahead of it.

What would you do if a decade-long contract you'd built your business plan around disappeared in a single email? Key Takeaways CMS shut down Making Care Primary (MCP) in 2025, just one year into a planned 10-year program, leaving nearly 700 practices across eight states scrambling for alternatives. Its replacement routes funding through health care organizations and companies instead of directly to frontline clinicians. CMS projected $750 million in taxpayer savings from endi

The 340B program, named for Section 340B of the Public Health Service Act (PHSA), was created in 1992 to help safety-net hospitals, federally qualified health centers, and other qualifying providers purchase outpatient drugs at significantly reduced prices. The intent was straightforward: stretch limited federal resources to serve low-income and uninsured patients.

If you think private equity is just a Wall Street story, think again. Private equity investors are quietly rewriting the rules of health care delivery, putting insurance carriers, agents, and digital marketers directly in the line of fire. Key Takeaways: Health care private equity deal volume rose nearly 10% in 2025, and 2026 is shaping up to be an even stronger year as the regulatory landscape stabilizes. Ambulatory surgery centers, skilled nursing, and specialty pharmacy ar

When your competitors are retreating from a market, is that your signal to exit or your invitation to dominate? The health care industry's next chapter is being written in primary care clinics across Florida. Key Takeaways: Humana closed its acquisition of Tampa-based MaxHealth, adding 54 primary care clinics to its CenterWell division The deal, valued at approximately $1 billion, brings 120,000+ Medicare and Medicaid patients into Humana's care network While CVS Health and U

When enhanced subsidies for Affordable Care Act (ACA) marketplace plans expired, millions of Americans faced sticker shock. Net premiums for subsidized enrollees more than doubled almost overnight, creating an opening that alternative coverage providers were ready and waiting to exploit.

What if your business is missing out on revenue simply because legitimate claims aren't being challenged when they're denied? Key Takeaways: Surging volume —Medicare Advantage prior authorization requests hit 52.8 million in 2024, up 42.3% jump since 2019. Rising denials —Denial rates climbed from 6.4% in 2023 to 7.7% in 2024, with major carriers denying more than 10% of requests. Appeal advantage —While only 11.5% of denials are appealed, 80.7% of those appeals are successfu

Will the EHR giant that dominates hospital systems redefine what AI actually means for health care delivery? Key Takeaways: Epic is positioning its AI charting tool as an "active assistant" rather than a passive scribe, tightly integrated with its EHR system Early adopters report saving 60 minutes per day through personalized voice agents and customizable documentation By taking a focused approach, Epic is solving specific problems rather than deploying AI everywhere Epic's s

What happens when the referee and the players both use the same playbook? Healthcare is experiencing an unprecedented AI arms race. Providers are deploying artificial intelligence to protect revenue streams. Payers are using similar technology to manage costs. And caught in the middle is a system that's becoming more efficient at everything except the thing that matters most: getting patients the care they need without financial devastation.

CMS's proposed 0.09% payment increase and chart review crackdown signals a seismic shift in Medicare Advantage economics that will separate operationally excellent insurers from those reliant on aggressive coding strategies.