Deadline nears for deciding whether to partake in $2.8 billion Blue Cross Blue Shield settlement
In less than two weeks, healthcare providers face a deadline to decide whether to stay in a record-setting settlement stemming from a class-action lawsuit against Blue Cross Blue Shield (BCBS). The $2.8 billion settlement, a portion of which is available to any provider that furnished items or services to a Blues plan member between July…
Trump administration starts to tweak the Affordable Care Act as subsidy debate looms
Coming off a period of record enrollment, the Affordable Care Act (ACA) insurance marketplaces face the prospect of constriction in upcoming years. The Trump administration quickly moved to limit federal funding for a program that helps people select an ACA health plan. On Feb. 14, the administration announced that funding for the ACA Navigator program…
RFK Jr. officially becomes HHS secretary as pressing healthcare policy questions mount
Robert F. Kennedy Jr. was sworn in Feb. 13 as the new secretary of HHS, and current events in healthcare policy make clear that he’ll be busy in the role. With the Senate having confirmed him by a partisan vote of 52-48, Kennedy faces urgent matters aside from generating momentum for his signature policy of…
Various 340B issues mean potential headaches for providers in 2025
The 340B Drug Pricing Program, a key source of cost savings for participating hospitals, faces intensifying pressure in the early part of the new year. Drug companies are pursuing efforts to limit the ability of hospitals to realize their full allotment of savings, while Congress eyes the program as a possible way to trim federal…
Latest on the Affordable Care Act marketplaces: Will recent enrollment surge be short-lived?
In its final days, the Biden administration tried to cement gains made during the past few years in the uptake of insurance coverage provided through the Affordable Care Act (ACA) marketplaces. A final rule published Jan. 15 seeks to carry the recent momentum into 2026 via small steps and technical updates such as changes to…
Direct-to-employer benefit design: A providers’ starter guide
Following a decade of experience in developing value-based care bundle programs, Nashville, Tenn.-based Vanderbilt University Medical Center (VUMC) has enjoyed success in direct contracting with employers that demonstrates the ripe market opportunity such contracting offers. Health systems that want to seize this opportunity can benefit from applying VUMC’s lessons learned during this process to their…
Medicaid funding questions swirl after White House orders widespread spending pause (updated)
Jan. 29 update: The White House on Wednesday retracted the OMB memo implementing the general pause of federal grant and loan spending, saying a stringent review of agency spending nonetheless will continue and funding for agencies and programs could still be frozen if deemed to be used in a way that’s contrary to the administration’s…
Proposed MA rate notice for 2026 looks promising for health plans, which soon could reap more gains
The Biden administration’s final action with respect to Medicare Advantage (MA) provided a boost to health plans, which could fare better yet under the Trump administration. For 2026, MA plans would receive a 2.23% increase in their payment benchmarks, according to an advance rate notice posted Jan. 10. That would represent a reversal from 2024…
How ACOs should prepare for the 2025 requirements around quality reporting
This year, MSSP ACOs face increased pressure to enhance care quality and manage costs with the transition from manual to electronic clinical quality measures (eCQMs) and the MSSP’s intensified compliance requirements. This shift to electronic reporting is a financially driven transformation. The reporting complexity has increased significantly as ACOs are now required to report on…
GOP puts ideas for major healthcare spending cuts in writing
Big healthcare provisions and programs face the prospect of cutbacks as congressional Republicans look to pass a budget for the remainder of FY25. With Donald Trump in place for a second presidential term starting Monday afternoon and narrow Republican majorities in both chambers of Congress, the GOP has a chance to influence federal policy on…