Category: News

August 26, 2025

Alex Kacik

Concierge and direct primary care practices are gaining traction among physicians, employers and patients increasingly frustrated with traditional care pathways.

The growth of these practices, where patients pay membership fees in exchange for increased access to physicians, is a symptom of Medicare and Medicaid reimbursement that has not kept pace with inflation, advisers, doctors and policy experts said. Growing care backlogs, coding and documentation tasks that take doctors away from patients and seemingly ever-rising health insurance premiums are also contributing, they said.

September 11, 2025

Lauren Dubinsky

Hospitals could see another popular procedure move to ambulatory surgery centers if it is reimbursed by the Centers for Medicare and Medicaid Services.

Cardiac ablations are among a larger group of procedures CMS is considering adding to the list of procedures they would cover at ASCs and industry groups have advocated for their inclusion for years. Currently, the agency only reimburses the procedures in hospital and hospital outpatient settings.

September 10, 2025

Caroline Hudson

Kaiser Permanente and Renown Health signed an agreement to form a joint venture to operate a health plan and ambulatory care services in Nevada.

As part of the deal, Kaiser would acquire a majority stake in Renown’s insurance arm, Hometown Health, which has more than 73,000 members. Kaiser plans to start offering health plan coverage in northern Nevada as Kaiser Permanente Nevada with an open enrollment period late next year, according to a Wednesday news release.

August 04, 2025

Caroline Hudson

Private equity deals in healthcare this year may not be on the downward spiral investors initially feared, according to a PitchBook report released Tuesday.

“The ‘sluggish start’ to PE healthcare services dealmaking that we noted in our Q1 update has evolved into slow but steady activity — below last year’s levels but far from a collapse,” the report said.

PitchBook estimates 322 healthcare services deals closed in the first half of 2025, compared with 339 deals in the first half of 2024.

July 14, 2025

Bridget Early

The base Medicare rate for doctors would rise 2.5% in 2026 under a proposed rule the Centers for Medicare and Medicaid Services published Monday.

President Donald Trump and Congress mandated this one-year boost to physician reimbursement in the tax bill that became law this month. That same statute offers a higher increase for doctors participating in alternative payment models.

CMS proposed Medicare reimbursement cuts the previous five years. Congress intervened to forestall them in most cases, but not this year, when doctors saw a 2.9% reduction.

July 01, 2025

Caroline Hudson

The Senate brought the One Big Beautiful Bill Act of 2025 and its more than $1 trillion in cuts to Medicaid and other healthcare programs one critical step closer to President Donald Trump’s desk Tuesday.

Healthcare organizations have sharply criticized the legislation since Trump and the Republican majority in Congress began working on the measure in January. Following the Senate action, trade associations slammed the bill, saying it would devastate providers and patients.

June 23, 2025

Nona Tepper
Bridget Early

UnitedHealth Group, Elevance Health, Aetna, Cigna and more than 40 other health insurance companies on Monday jointly announced an initiative to streamline prior authorizations.

Under the auspices of leading industry groups AHIP and the Blue Cross Blue Shield Association, the coalition of for-profit and nonprofit insurers pledged to reduce what providers characterize as the ever-increasing burden of obtaining precertifications for care.

June 10, 2025

Nona Tepper  
Bridget Early 

Having a Republican in the White House historically has been good for Medicare Advantage insurers, and President Donald Trump’s victory in November had the sector anticipating relief after a challenging four years under President Joe Biden.

So far, it’s not working out that way. Although the Centers for Medicare and Medicaid Services gave Medicare Advantage plans a rate increase for 2026 after it cut payments for two consecutive years during the Biden administration, CMS has maintained most of the more stringent oversight Trump’s predecessor put in place.

May 22, 2025 

Michael McAuliff   

The House passed a sweeping tax-and-spending cuts bill Thursday that would dramatically reshape the healthcare system by slashing more than $1 trillion from Medicaid and other programs.

The majority Republican lower chamber voted 215-214 to approve the One Big Beautiful Bill Act of 2025 just before 7 a.m. EDT after an all-night floor debate. Attention now shifts the GOP-led Senate, which has not commenced public debate on its tax measure.

April 28, 2025 

Lauren Berryman   

Elevance Health is facing a second lawsuit accusing it of maintaining inaccurate provider directories, also known as “ghost networks.”

The plaintiffs are three people covered under New York state employee health benefits who allege that Elevance Health division Carelon Behavioral Health misrepresented providers as in-network, causing them financial harm. The attorneys are seeking class-action status.

Legal experts expect “ghost network” lawsuits to spread. Health insurers have long faced criticism for faulty provider directories.