UnitedHealthcare Limits RPM Coverage While Medicare RPM Expands in 2026
UnitedHealthcare limits RPM coverage to select conditions in 2026 amid growing Medicare RPM use, signaling shifts toward value-based care and enhanced oversight.
Humana Announces Leadership Changes in Medicare Advantage and Insurance Segments
Humana appoints Aaron Martin as President of Medicare Advantage, reshaping its insurance segment leadership ahead of George Renaudin's retirement in 2026. This transition aims to strengthen operational excellence and market position in Medicare and Medicaid.
AMA 2024 Study Highlights High Concentration in U.S. Health Insurance Markets
The AMA's 2024 report reveals significant concentration in U.S. commercial and Medicare Advantage health insurance markets, raising concerns over competition and consumer choice.
Medicare Advantage Contract Dispute in Washington Highlights Vertical Integration Risks
A contract dispute between Optum and Humana in Washington state spotlights risks of vertical integration in Medicare Advantage, impacting senior beneficiaries and market competition.
Humana's Medicare Advantage Clinics Report Higher Hospital Use Than Publicly Stated
Internal Humana data revealed higher hospitalization rates in their Medicare Advantage clinics than publicly reported, raising questions on integrated care outcomes and investor transparency.
Humana Fair Value Increases Slightly Amid Mixed Analyst Views on Medicare Advantage Outlook
Humana's fair value rises slightly on stronger revenue growth assumptions despite mixed analyst ratings amid Medicare Advantage regulatory challenges and sector cyclicality.
Legislation Targets AI-Based Medicare Prior Authorization Pilot in Washington
U.S. Senators propose legislation to halt CMS AI-powered Medicare prior authorization pilot in six states including Washington due to care delay concerns.
2027 Medicare Advantage and Part D Proposed Rule: CMS Modernizes Quality Metrics and Risk Adjustment
CMS 2027 Proposed Rule aims to modernize Medicare Advantage and Part D programs with updates to quality metrics, risk adjustment models, and beneficiary protections. Key changes include Star Ratings revisions, incorporation of Inflation Reduction Act drug pricing provisions, and requests for stakeholder feedback on quality bonus payments and care coordination.
2026 Payer IT Modernization: CMS Compliance, Interoperability, and Cybersecurity Driving Outcomes
Discover how 2026 CMS compliance deadlines and cybersecurity expectations are reshaping payer IT with FHIR interoperability, prior authorization modernization, and outcomes-driven digital strategies.
Clever Care Partners with Blue Zones Health to Enhance Culturally Competent Medicare Advantage Care
Clever Care Health Plan partners with Blue Zones Health to connect Medicare Advantage members with providers focused on longevity and culturally competent preventive care in Southern California.