Will Tennessee’s PBM Bill Face the Same Fate as Arkansas’ Law?
Tennessee lawmakers recently passed a bill banning PBMs from owning pharmacies in the state, though like a similar Arkansas law, it is expected to face legal challenges if enacted.
Musculoskeletal Disorders Are Draining Employer Health Budgets — The Workplace Itself May Be the Cause
Benefits leaders have become increasingly sophisticated in managing pharmacy spend and high-cost claims. MSK deserves similar strategic attention – not only because it is expensive, but because it is largely preventable.
The Power Behind Enterprise EHR Software for Large Healthcare Systems
Enterprise EHR boosts scalability, interoperability, and governance for large healthcare systems.
Bipartisan Bill Seeks to Strengthen Oversight of Medicare Advantage
Lawmakers introduced the Medicare Advantage Improvement Act of 2026 to tighten prior authorization rules, boost transparency and curb practices that delay care.
As Health Costs Hit Record Highs, Brokers Face a Structural Test
This is forcing brokers to rethink how they serve clients and how their businesses continue to grow without sacrificing service.
SCAN CEO Urges Brokers to Drop Plans That Treat Them Poorly — One Says She Has No Choice
SCAN Health Plan CEO Sachin Jain urged brokers to abandon for-profit plans that treat them poorly, but one broker argued they often can’t because dominant players like UnitedHealth Group control so much of the healthcare system.
How the DOJ Is Tackling Fraud in the ACA Marketplace
At the Medicarians Conference, Ricardo Carcas, assistant special agent in charge of the Office of Investigations, discussed cases of fraud in the ACA and how the DOJ is combatting it.
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Inside an Automated Healthcare Practice: Redesigning Care Around People, Not Paperwork
By reducing administrative burden and redesigning workflows around human needs, it creates space for what matters most: connection between clinicians and patients.
Oscar Health Seeks to Build ‘Airbnb for Healthcare’ with New Marketplace, CEO Says
Oscar Health launched Lucie, a marketplace aimed at making healthcare more shoppable.
Expanding the CJR Model Is a Logical Step in VBC, but Implementation Challenges Remain
CMS is proposing to make its joint replacement bundled payment model mandatory nationwide. Experts say it is a logical step, but warn that mandatory participation could be challenging for hospitals to implement.
Behavioral Health Demand Has Increased by 62% Since 2018. What the Industry Needs to Know
A new report from Trilliant Health finds behavioral health demand has surged since 2018, but workforce shortages and access barriers continue to limit care.
New Bill Seeks to Lower Out-of-Pocket Drug Costs
Rep. Greg Murphy introduced a bill that would require out-of-pocket prescription drug spending to count toward patients’ deductibles and out-of-pocket maximums regardless of where the drugs are purchased.
The Hidden Administrative Tasks Draining Small Practices
Small practices play a critical role in healthcare delivery, but they cannot continue to absorb ever-increasing administrative demands without consequences.
Vida Health Teams Up with ŌURA to Provide More Personalized Metabolic Care
Vida Health is partnering with ŌURA to use data from the Oura Ring to provide more continuous, personalized cardiometabolic care and improve patient outcomes.
Report: Growth in MA Is Associated With Lower Total Medicare Spending
New research from the Elevance Health Public Policy Institute finds that higher enrollment in Medicare Advantage may be linked to lower overall Medicare spending.
‘A Significant Assault on Our Health’: Healthcare Policy Leaders Condemn Trump’s Budget Proposal
President Donald Trump’s 2027 budget proposes deep healthcare cuts, raising concerns about harm to patients and research.
Insurers have Cut Prior Auth by 11% Following Commitments
Health insurers have reduced prior authorizations by 11% and are continuing reforms to streamline and speed up approvals, according to an announcement from AHIP and Blue Cross Blue Shield Association.
Do Healthcare CEOs Agree on Whether VBC and MA Actually Save Money?
Healthcare leaders can’t tell whether value-based care and Medicare Advantage are truly lowering costs. Some see promise in these models and ongoing innovations, while others say the programs haven’t delivered measurable savings and point to direct contracting as a more transparent way to control spending.