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CMS calls back furloughed employees to help with Medicare, ACA enrollment periods
Roughly 3,000 employees are coming back to work on Monday, funded by user fees as the shutdown drags into its fourth week.
By Rebecca Pifer • Oct. 24, 2025 -
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Ballad Health sues UnitedHealth for Medicare Advantage ‘manipulation’
The Appalachian system said it is turning to the courts as a last resort after failing to resolve years of payment and patient care issues.
By Rebecca Pifer • Oct. 24, 2025 -
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 -
Permission granted by Optum
Optum taps its second CFO in 6 months
It’s the latest management shakeup at UnitedHealth as the company attempts to shore up investor confidence.
By Rebecca Pifer • Oct. 24, 2025 -
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Molina slashes 2025 profit guidance again on ACA woes
Molina’s profit in the third quarter plummeted as the insurer was hit with an increase in marketplace medical costs that one analyst called “staggering.”
By Rebecca Pifer • Oct. 23, 2025 -
Courtesy of HLTH 2025
HLTH25Top RFK aide lashes out against healthcare industry for profiting off of illness
Calley Means stopped short of accusing hospitals, insurers and drug companies from actively working to keep Americans sick, but said it was an "economic fact" that the companies benefit financially when people are ill.
By Susanna Vogel • Oct. 22, 2025 -
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‘A quiet alarm bell going off’: Job-based family coverage hits $27K annually
Premium increases are outpacing wage growth and general inflation at a time of intense focus on healthcare affordability, according to new research from KFF.
By Rebecca Pifer • Oct. 22, 2025 -
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HLTH25
Optum launches AI system to speed medical claims
Optum Real allows providers to receive information about patients’ health benefits in real time, the company said.
By Emily Olsen • Oct. 22, 2025 -
Emily Olsen/Healthcare Dive/Healthcare Dive
HLTH25Medical billing firm Cedar launches Medicaid enrollment tool as cuts loom
The tool, which aims to help patients enroll in and maintain coverage, comes as healthcare braces for major cuts to the safety-net insurance program.
By Emily Olsen • Oct. 21, 2025 -
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Elevance outperforms in third quarter but warns of Medicaid challenges
The Indianapolis-based company is the first major insurer to release earnings this cycle. Elevance did well in the quarter, but hinted that profits could be constrained in 2026.
By Rebecca Pifer • Oct. 21, 2025 -
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OpinionBeyond one-size-fits-all: How ICHRA empowers employees and employers
ICHRA plans, a nascent form of health coverage, are gaining traction, argues an executive of Centene subsidiary Ambetter Health.
By Alan Silver • Oct. 16, 2025 -
Rebecca Pifer/Healthcare Dive
Oz reiterates need to improve Medicare Advantage payment accuracy
The CMS administrator’s comments at an industry event in D.C. reflect the difficult tightrope regulators in the Trump administration walk as they pursue MA reform.
By Rebecca Pifer • Oct. 15, 2025 -
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California passes laws targeting PBMs, private equity
Gov. Gavin Newsom signed an array of healthcare bills into law last week that crack down on pharmacy benefit managers and beef up the review process for deals involving private equity firms.
By Susanna Vogel • Oct. 15, 2025 -
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Healthcare AI investment focused on profit margins, ROI: report
As providers and payers navigate an increasingly challenging financial environment, executives are targeting AI tools that show a clear return on investment, according to a report by Klas Research and Bain & Company.
By Emily Olsen • Oct. 15, 2025 -
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Senate Finance Committee probes Medicaid contractors over faulty systems
Top Democrats are airing related concerns that the IT chassis underpinning states’ Medicaid operations may not be robust enough to withstand the added pressure from looming work requirements.
By Rebecca Pifer • Oct. 15, 2025 -
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Humana loses Medicare Advantage stars lawsuit for a second time
A federal judge ruled in favor of the CMS on Tuesday, one day before the start of Medicare open enrollment. A spokesperson for Humana said the insurer is considering “all available legal options.”
By Rebecca Pifer • Oct. 14, 2025 -
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Top Democrat questions Medicare Advantage insurers on AI claims denials
The letter from Sen. Richard Blumenthal comes one year after a Senate investigation criticized major MA payers for using predictive technology to deny post-acute care.
By Emily Olsen • Oct. 14, 2025 -
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Sponsored by West MonroeNavigating the perfect storm: Cost pressures and regulatory challenges
Healthcare’s perfect storm: soaring costs, shifting regs and AI’s role in survival.
By Esteban López, MD, MBA Partner, Healthcare • Oct. 13, 2025 -
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Winners and losers from 2026 Medicare Advantage star ratings
The CMS quietly released anticipated star ratings data Thursday night. Humana and Aetna saw enrollment in highly rated plans fall, while Elevance’s and Centene’s stars improved and UnitedHealthcare’s stayed stable.
By Rebecca Pifer • Oct. 10, 2025 -
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Pharmacy groups defend Iowa PBM law amid legal challenge
The state passed the law in June in a bid to protect independent pharmacies from certain harmful pharmacy benefit manager practices, but it was quickly tied up in litigation.
By Rebecca Pifer • Oct. 9, 2025 -
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UnitedHealthcare swipes at Johns Hopkins, Capital Women’s Care in contract brawl
The insurer accused the health systems of putting business interests over patient well-being in recent failed contract negotiations.
By Susanna Vogel • Oct. 8, 2025 -
Sara Samora/Healthcare Dive
Influential PBM lobby appoints top Express Scripts executive as board chair
Adam Kautzner will oversee the PCMA’s strategy as chair of the board, including its defense of pharmacy benefit managers amid growing scrutiny of their role in rising drug costs.
By Rebecca Pifer • Oct. 8, 2025 -
Permission granted by Aspen Institute
Oz speaks out about shutdown, Medicaid cuts, Medicare Advantage audits and more
Six takeaways from the CMS administrator’s appearance at a D.C. think tank — including why he supports a clean funding bill to reopen the government.
By Rebecca Pifer • Oct. 7, 2025 -
Courtesy of UnitedHealth Group
Shareholder group calls on UnitedHealth to decouple CEO from board chair
Stephen Hemsley is the chairman of UnitedHealth’s board and its CEO. The Accountability Board says that undercuts corporate governance at a turbulent time for the company.
By Rebecca Pifer • Oct. 6, 2025 -
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No Surprises dispute resolution remains operational despite shutdown
However, a prolonged lapse in funding could affect other activities underpinning implementation of the law that holds consumers blameless for unexpected out-of-network bills.
By Rebecca Pifer • Oct. 6, 2025 -
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Medicaid enrollees at risk of disenrollment report multiple chronic conditions: study
About 41% of beneficiaries who could lose coverage due to federal work requirements signed into law this summer have three or more chronic conditions, according to new JAMA research.
By Emily Olsen • Oct. 6, 2025
