More Insurance Claims Denials Are Being Overturned upon Appeal, Study Finds
A new JAMA study of roughly 51,000 New York claims shows denial overturn rates climbing from 38% in 2019 to nearly 53% in 2025. Overturn percentages differ sharply by service type—more than 78% for home‑health claims and just over 50% for prescription‑drug or dental claims. Insurers such as Metroplus, Elevance’s Anthem subsidiary, UnitedHealthcare and CVS Aetna posted overturn rates ranging from 36% to 85%, suggesting uneven review standards. Researchers warn the trend signals systemic flaws in coverage‑review processes and call for policy attention.
With Health Costs Ballooning, Workers Turn to Wellness and the Internet, ADP Finds
ADP’s latest employee benefits survey shows soaring health‑care costs are prompting workers to delay or forgo treatment. Twenty‑six percent skipped needed care and 22% cut medication use, both up from 2020 levels. To cope, 68% of employees now seek medical...
Tenet CIO to Retire at Year End
Tenet Healthcare announced that Chief Information Officer Paola Arbour will retire on Dec. 31, 2026, but will remain on a part‑time basis through early 2028 to aid the transition. Arbour, who has led Tenet’s IT strategy, operations and finances since 2018,...
CMS Accepts More than 150 Providers, Digital Health Firms for ACCESS Model
The Centers for Medicare & Medicaid Services (CMS) has granted provisional approval to more than 150 providers and digital‑health firms for its Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model. The 10‑year experiment, launching in July, will pay participants...
CMS Proposes New Deadlines for Prior Authorizations for Drugs
The Centers for Medicare & Medicaid Services (CMS) has proposed a rule that would impose firm deadlines on federally regulated insurers for electronic prior authorizations (PA) of prescription drugs. Medicaid and CHIP plans would have 24 hours to respond, while ACA...
Fix Operations, Not Contracts: How to Make Value-Based Care Work
Value‑based care (VBC) is stalling because providers focus on payment incentives rather than the operational changes needed to deliver coordinated, outcome‑driven care. A 2025 provider survey shows two‑thirds view analytics as essential, yet over half cite data quality and interoperability...
From Afterthought to Advantage: How Health Plans Are Rethinking Post-Acute Care
Health insurers are moving post‑acute care from a reactive afterthought to a proactive advantage. Real‑time clinical visibility and AI‑driven risk models now let care teams intervene while members are still in transition, rather than waiting for claims data. Integrated workflows...
From Vision to Reality: How Ambulatory Practices Actually Become Automated
Automation in ambulatory care is shifting from a buzzword to a daily reality, but success hinges on more than software. Practices that first map and standardize workflows—intake, eligibility, prior authorizations—create a solid foundation for automation tools. Engaging frontline staff early...
Hospital M&A Rebounds After 2025 Lull
Hospital and health‑system M&A rebounded in Q1 2026, with 22 announced deals—the highest first‑quarter total in six years. The quarter’s transacted revenue hit $14.5 billion, buoyed by several mega‑mergers exceeding $1 billion in annual revenue. Divestitures dominated, accounting for 15 of the...
Most Health AI Users Don’t Rate Chatbots as Highly Accurate: Poll
A recent Pew poll of over 5,000 U.S. adults shows that while more than 20% occasionally use AI chatbots for health questions, only 18% consider the information very or extremely accurate. By contrast, 65% trust their providers for accurate advice,...
Orlando Health Agrees to Acquire Alabama-Based RMC Health System
Orlando Health announced an agreement to acquire Anniston‑based RMC Health, adding a 375‑bed hospital and outpatient network to its Alabama region. The transaction, which awaits regulatory clearance, is slated to close in the fall of 2026. This follows Orlando Health’s...
ICHRAs, a Growth Opportunity for Insurers, Face Uphill Battle
Individual Coverage Health Reimbursement Arrangements (ICHRAs) are gaining traction as insurers search for growth amid stagnant commercial plan enrollment. Adoption jumped 19% from 2024 to 2025, with a 34% surge among large employers, prompting payers like Centene and Oscar to...
Digital Health Funding Concentrates in Fewer Startups: Report
Digital health startups secured $4 billion in the first quarter of 2026, up $1 billion from a year earlier, but the capital was funneled into fewer deals. Only 110 transactions occurred, down from 122, while a dozen mega‑deals of $100 million or more...
Jefferson Health Sues Aetna over Medicare Advantage ‘Downcoding’ Policy
Jefferson Health and Lehigh Valley Physician Hospital Organization have filed a federal lawsuit against Aetna, alleging that the insurer’s new “downcoding” policy unlawfully reduces Medicare Advantage inpatient payments. The policy classifies 1‑4 night admissions as low‑severity and reimburses them at...
Veradigm Names CFO as It Works to Get Current on Financial Filings
Veradigm announced Christian Greyenbuhl will become its chief financial officer, effective May 11 or the day after the company files its overdue 2023 and 2024 annual reports. The health‑IT firm was delisted from Nasdaq in early 2024 after missing quarterly and annual...
