US health spending spikes to $5.7T in 2025, though growth should moderate, CMS finds

The Latest

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  Democrats push for more data on Medicare AI prior authorization pilot

  The letter to the CMS from Democrats is the latest salvo from lawmakers concerned that WISeR is delaying care to Medicare beneficiaries.

  Health IT

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  Sponsored by Amazon Business

  Optimizing healthcare procurement: 5 challenges and best practices

  Healthcare procurement is a cornerstone of your organization’s operations, but it comes with unique challenges.

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  Centene adds JPMorgan veteran to board

  Incoming board member Lauren Tyler has more than 30 years of leadership experience in the finance world, which could help Centene navigate the challenging operating environment facing insurers.

  Payer

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  Hackensack Meridian Health, Hunterdon Health explore merger in New Jersey

  No one’s going out of business without a merger, as both HMH and Hunterdon are on stable financial footing. But a combination will give the systems added heft to tussle with competitors, according to executives.

  Hospitals

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  HCA’s chief clinical officer to exit after 4 years

  Dr. Michael Cuffe, who assumed the role in 2022, is leaving at the end of August.

  Hospitals

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  Hospitals irate after Eli Lilly follows through on 340B ultimatum

  The drugmaker stopped paying 340B discounts to hospitals that didn’t comply with its new paperwork requirements late last week. Hospitals are urging HRSA to step in.

  Hospitals

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  MultiCare CEO to retire at end of 2026

  Florence Chang, a long-time executive of the Washington-based nonprofit, will replace current CEO William Robertson on Jan. 1.

  Hospitals

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  HHS, responding to China’s rise, moves to fast-track early drug research

  A series of newly planned reforms are designed to entice companies to start early trials in the U.S. rather than overseas.

  Government

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  Health services M&A is active in 2026, but uncertainty slows volume: PwC

  Buyers are being more selective amid heightened policy and reimbursement pressure in healthcare, according to the analysis. Still, deal value is up compared to the first half of 2025.

  Finances

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  CMS recalculates Medicare Advantage stars after Clover lawsuit loss, but not a freebie for plans

  Regulators are locking in new 2026 stars for plans if they’re higher under the new methodology. But the recalculation basically results in no change to average star ratings unless you’re Clover, analysts say.

  Payer

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  PCMA sues to exempt PBMs from Illinois drug law

  It’s the second major lawsuit the pharmacy benefit manager lobby has filed against a state law reforming the industry in recent weeks.

  Payer

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  Q&A

  Can certification help solve healthcare’s AI governance gap?

  Joint Commission leaders explain how the standards group’s new AI certification is designed to work for everyone from major health systems to small rural clinics.

  Health IT

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  Employers plan to shift more health costs to employees

  Employers are considering raising premiums and increasing other forms of cost sharing as they grapple with stubbornly rising health costs, according to a new survey from Mercer.

  Payer

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  OhioHealth settles antitrust suit with the DOJ

  OhioHealth has agreed to void problematic contracts with insurers and not seek such terms moving forward, the Justice Department said. The Ohio nonprofit continues to deny all wrongdoing.

  Hospitals

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  CBO asks for more No Surprises research

  The No Surprises Act “might not have the effects that CBO anticipated,” the agency wrote in petitioning for more research into the 2020 law’s effect on healthcare prices and other trends. It’s a welcome development for payers.

  Payer

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  Lifepoint taps new COO

  Aaron Lewis, who has served as CFO since 2024, takes on the role as the health system looks to expand its footprint and add new services.

  Hospitals

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  Fewer insurers participating in ACA marketplaces amid policy turmoil, KFF finds

  The average number of issuers fell from a record high of 9.6 per state in 2025 to just nine this year, according to the health policy research group.

  Payer

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  Centene offers employee buyouts amid membership losses

  Most of Centene’s 61,000 employees will be eligible to apply for voluntary separation. But the program doesn’t amount to a complete overhaul of the company, a spokesperson said.

  Payer

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  IRhythm discloses data stolen from third-party applications in cyberattack

  The cardiac monitoring company said that a threat actor has demanded payment in exchange for not publicly releasing the stolen data.

  Health IT

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  Express Scripts, PCMA sue to block Tennessee law breaking up PBMs and pharmacies

  Express Scripts and the PBM lobby are following in CVS Caremark’s footsteps in filing complaints challenging the FAIR Rx Act, which was passed earlier this year despite vehement opposition from PBMs.

  Payer

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  CMS proposes Medicare coverage expansion for TAVR

  The proposed change adds Medicare coverage for beneficiaries with asymptomatic severe aortic valve stenosis who are enrolled in a CMS-approved study.

  Government

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  Judge vacates most of controversial 2025 ACA enrollment, eligibility rule

  Friday’s decision is a victory for insurance advocates. But, given many of the rule’s provisions were codified in the GOP’s “Big Beautiful Bill,” it’s not a panacea for the ACA.

  Payer

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  UnitedHealth, FTC reach proposed settlement in insulin case

  The tentative deal comes months after CVS reached a proposed settlement in the lawsuit alleging major PBMs are inflating insulin costs. Cigna has already settled with the FTC.

  Payer

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  Medicare drug price rule may target under-the-skin cancer immunotherapies

  For 2029, a federal rule proposes closing a "loophole" that protects medicines transitioning from intravenous administration from price protection.

  Government

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  Major Medicare Advantage insurers appear to deny care for profit, federal watchdog finds

  MA insurers commonly deny requests for post-acute care — but none more frequently than UnitedHealth, Humana and CVS, the HHS OIG said. Insurers were not happy about the findings.

  Payer

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  CMS increases oversight of state Medicaid demonstrations

  States will have to provide more rigorous financial analyses for their Medicaid demonstrations beginning in 2027, according to new federal guidance.

  Payer

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