New & Notable
New analysis estimates $1.1T in Medicaid improper payments
A new analysis estimates $1.1 trillion in Medicaid improper payments over a decade, nearly double CMS's reports, largely due to overlooked eligibility errors.
Commercial insurance coverage for GLP-1s still limited
Fewer insured people have coverage for GLP-1s, while more are beholden to prior authorization and step therapy before gaining access to the drugs.
Medicare Advantage enrollees underuse supplemental benefits
Medicare Advantage beneficiaries find value in supplemental benefits like dental and eye exams, but survey data shows that these benefits are underused.
What are the implications of Medicaid per capita caps?
Medicaid per capita caps would decrease federal spending, creating a choice between increased state spending and enrollee coverage.
Insights
Insights is research conducted by and for TechTarget Xtelligent Healthcare. Our work aims to leverage Xtelligent’s diverse readership of healthcare professionals across various sectors of the industry to understand real-world challenges and identify effective solutions.
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A podcast for healthcare professionals seeking solutions to today's and tomorrow's top challenges. Hosted by the editors of Xtelligent Healthcare Media, this podcast series focuses on real-world use cases that are leading to tangible improvements in care quality, outcomes, and cost.
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Latest News
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U.S. healthcare spending soars on diabetes, heart diseases
Cardiovascular diseases were the costliest conditions, while U.S. healthcare spending on type 2 diabetes beat out other single conditions, according to a new study.
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Downside risk in healthcare improves MA outcomes
Medicare Advantage with downside risk improves care, cutting hospital visits, high-risk medication use and enhancing efficiency compared to fee-for-service MA.
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HealthCare.gov's 2023 in-network claim denial rate hit 1 in 5
High in-network claim denial rates continue to be a key source of plan member dissatisfaction.
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CMS releases final ACA marketplace payment notice for 2026
The 2026 updates to the ACA marketplace include calculation updates for risk adjustment, slight changes to cost-sharing reduction loading practices and more.
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2025 ACA open enrollment breaks records with time to spare
This ACA open enrollment season saw 3.2 million new enrollees enter the marketplace and those numbers could grow before the season ends on Jan. 15, 2025.
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How to overcome weaknesses in Medicaid postpartum coverage
Medicaid postpartum coverage extensions have been critical, but states face challenges addressing access to care, quality of care and MCO accountability.
Features
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How companies find solutions to employer GLP-1 coverage
Employer GLP-1 coverage has serious cost barriers, but some companies are turning to technology vendors to provide a comprehensive approach to access.
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Employers seek healthcare price transparency to control costs
Navigate rising costs by leveraging healthcare price transparency, direct provider contracts and data access, despite ongoing challenges for employers.
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What does member experience mean for health payers?
A better member experience is key for health payers working to improve consumer loyalty and support their financial bottom lines.
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Top cybersecurity strategies for healthcare payers
Healthcare payers can conduct internal risk assessments, train employees and stay informed about upcoming regulations to bolster cybersecurity efforts.