Why health plans are leaving surgical cost savings on the table

Surgery avoidance isn’t enough. Outcomes optimization is critical to your cost of care efforts.

By Nicola Merryman, Senior Vice President, Healthcare Solutions, Paradigm • June 8, 2026

The evolution of healthcare cost management demands a new approach

The future of healthcare savings won’t come from bigger discounts—it will come from better alignment, accountability, and member experience.

By Michael Condon, SVP/GM PriceDynamix, AMPS • June 8, 2026

Elevance again avoids Medicare Advantage sanctions, but threat remains

The CMS pushed back sanctions until July 1 after Elevance made progress on fixing faulty data submissions for its privatized Medicare plans. But the company still has more to do, regulators said.

By Rebecca Pifer Parduhn • June 1, 2026

Cencora nabs ex-CVS exec as new CFO

Eva Boratto, who spent more than a decade at CVS in a variety of finance roles, will join the drug distributor later this summer, Cencora announced Wednesday.

By Rebecca Pifer Parduhn • May 27, 2026

Healthcare consumerism alone didn’t bend the cost curve. Here’s what it’s missing.

Consumer-driven plan design failed. Quality-driven design is next.

By Daniel Stein, MD, MBA, President and Founder, Embold Health • May 26, 2026

CommonSpirit $3.4B in the red amid billing contract exit, operational woes

The Catholic nonprofit giant’s expenses well outstripped revenue in the most recent financial quarter. Though the outcome was mostly due to one-time items, CommonSpirit also continues to struggle with boosting core operations.

By Rebecca Pifer Parduhn • May 19, 2026

Emergency medicine revenue at risk: Navigating the algorithmic squeeze

Diagnosis-based downcoding is surging. Emergency physicians are paying the price.

By Andrea Brault, MD, MMM, FACEP, CEDC • May 18, 2026

Worker strikes cost Kaiser over $1B in Q1

Strikes at Kaiser, including a monthlong work stoppage among 31,000 nurses and other employees, added to the nonprofit health system’s rising expenses in the first quarter, which dinged its operating margin.

By Sydney Halleman • May 12, 2026

Healthcare bankruptcies rise in Q1: report

The sector recorded 12 bankruptcy filings in the first quarter, up 33% from the fourth quarter of 2025, according to analysis by Gibbins Advisors.

By Emily Olsen • May 4, 2026

Cost management, outpatient unit helped Tenet weather volume headwinds in Q1

Executives said Tenet’s focus on managing expenses and growing high-acuity service lines helped it withstand poor volumes that battered some of its peers in the first quarter.

By Sydney Halleman • May 1, 2026

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

UHS reaffirms 2026 volume targets, despite seasonal hits in Q1

A weaker-than-expected respiratory season paired with winter storms caused UHS’ volumes to decline in the first quarter. Executives said they expect growth in the second half will help the operator meet earnings targets this year.

By Sydney Halleman • April 29, 2026

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

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

ACA subsidy lapse cost HCA Healthcare $150M in Q1

The hit was in line with HCA’s expectations. The hospital operator is the first of its peers to detail financial impacts from the expiration of more generous subsidies in Affordable Care Act plans.

By Sydney Halleman • April 27, 2026

Why 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

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

Flagging first-quarter volumes dragged CHS’ earnings

Executives said consumer fears and aggressive denials from payers fueled declining volumes in the quarter, leading CHS to a $58 million loss. Still, the hospital operator expects volumes to pick up in the back half of the year.

By Sydney Halleman • April 23, 2026

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

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

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

Fix operations, not contracts: How to make value-based care work

Value-based care isn’t just a payment shift—it requires a new operating model.

April 13, 2026

Standing up to rising prescription drug costs increases access to breakthrough medications

For millions of Americans, accessing the medications they need at prices they can afford has gotten increasingly difficult.

By Dr. Michelle Gourdine, Senior Vice President, CVS Health; Chief Medical Officer, CVS Caremark • April 7, 2026

Digital twins for spend are changing how finance teams monitor and optimize performance

Utilizing AI to structure all contract and invoice data, healthcare leaders are creating digital twins for spend to create a permanent advantage.

By Shannon Copeland, CEO, SIB Fixed Cost Reduction • March 23, 2026

Hospitals’ financial performance off to a shaky start in 2026: report

Rising bad debt and expenses challenged hospitals in January — and those pressures aren’t likely to abate, according to consultancy Kaufman Hall.

By Emily Olsen • March 20, 2026