In 2024, Americans spent approximately $5.3 trillion on healthcare, about $15,474 per person, and healthcare expenditures accounted for 18.0% of the country’s GDP.
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For the second consecutive year, 52% of health plan executives named “managing rising costs” as the top challenge, according to the 2026 HealthEdge® Annual Payer Report. In the same survey, 85% of...
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At HealthEdge®, we strive to understand the key challenges health plans face so we can help anticipate and address new market opportunities. Recently, HealthEdge Chief Strategy Officer, Raj...
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Rising costs. Relentless regulation. For health plans, the question isn’t whether these pressures are intensifying. It’s how to respond. According to new research from HealthEdge®, these twin...
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The Transparency in Coverage (TiC) final rules of 2020 promised a revolution in healthcare price transparency. The vision was bold: empower consumers with data to drive competition and lower...
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As regulatory and quality expectations intensify, the National Committee for Quality Assurance (NCQA) vendor certification offers health plans a trusted signal that their technology partners can...
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When state regulations change, health plans must be ready to respond—particularly when those changes impact core Medicaid services. That was the case in 2025 when the State of Texas mandated...
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Implementing new care management technology is about more than just meeting a go-live date. For Medicaid and Long-Term Services and Supports (LTSS) plans navigating evolving state mandates,...
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As the healthcare industry prepares for the ripple effects of the One Big Beautiful Bill Act (OBBBA), few payer segments face more immediate challenges than health plans focused on Medicaid...
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Dual-eligible individuals—those who qualify for both Medicare and Medicaid—represent one of the most complex and high-need populations in the U.S. healthcare system.
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Extensive legislative reform is shifting the healthcare landscape. The One Big Beautiful Bill Act (OBBBA) introduces significant changes to eligibility requirements across Medicaid, Medicare, and...
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The One Big Beautiful Bill Act (OBBBA) is reshaping healthcare, especially for Medicaid and Medicare plans. With tighter budgets, closer oversight, and an emphasis on population health in rural...
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In today’s evolving healthcare landscape, understanding what members want and need is more important than ever. To uncover those insights, HealthEdge conducted its 2025 Healthcare Consumer Study,...
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As regulatory guidelines evolve and the emphasis on improving healthcare access and outcomes intensifies, health plans that serve Medicaid and D-SNP populations face an urgent mandate to improve...
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Health plans serving dual-eligible populations face significant regulatory changes from the Centers for Medicare & Medicaid Services (CMS). The 2027 D-SNP requirements introduce significant...
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Pregnancy can be a particularly stressful time for members—especially for high-risk and first-time parents. A Maternal Health care program can send members timely health information...
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Medicaid programs nationwide are increasingly requiring and incentivizing health plans to incorporate whole-person care and the social determinants of health (SDOH) into their service models....
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The Centers for Medicare & Medicaid Services (CMS) has raised performance benchmarks for Medicare Advantage (MA) and Part D plans, raising the bar for achieving high Star Ratings. By excluding the...
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A strategy to comply with the final rule issued by the U.S. Centers for Medicare & Medicaid Services suggests that payers should unify systems around their core claims and care management platforms...
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