Plus, how health systems are addressing policy uncertainty

This Week

Jul 19, 2025

CMS proposes 3.6% pay bump for docs, takes aim at chronic conditions in physician fee schedule


Trump 2.0 backs digital health in proposed CY2026 physician fee schedule rule


CMS floats 2.4% annual outpatient, ASC pay bump alongside price transparency, site neutrality


CalPERS swaps OptumRx for Caremark in risk-based PBM contract


How health systems are reshaping their strategies in the face of federal policy uncertainty - Paige Minemyer  

 

Featured

CMS proposes 3.6% pay bump for docs, takes aim at chronic conditions in physician fee schedule

The Trump administration is proposing a pay bump for physicians in 2026, alongside new reforms that align with the agency's Make America Healthy Again positioning.
 

Top Stories

Trump 2.0 backs digital health in proposed CY2026 physician fee schedule rule

The second Trump administration proposed positive changes to digital health policy in the first Medicare physician fee schedule rule under RFK Jr. and Dr. Oz.

CMS floats 2.4% annual outpatient, ASC pay bump alongside price transparency, site neutrality

The 913-page proposed rule comes with its fair share of potential policy changes, which CMS said are intended to reduce beneficiaries’ out-of-pocket costs, expand care choices, increase hospital price transparency and clamp down on waste and abuse of Medicare funds.

How health systems are reshaping their strategies in the face of federal policy uncertainty

In the face of federal policy uncertainty, 86% of healthcare delivery organizations have contingencies in place—some are scaling back services and restructuring their workforce, while others are expanding high-reimbursement lines, according to a KLAS Research survey.

CalPERS swaps OptumRx for Caremark in risk-based PBM contract

A new pharmacy benefit manager contract for CalPERS, serving nearly 600,000 members, includes performance-based risk for CVS Caremark.

Modernized member communication remains a priority after Trump reconciliation bill

Trade organizations may have notched a small win in Trump's reconciliation bill with a provision allowing states to text enrollees about complying with work requirements, but Congress balked on wider changes.

M7 Health nabs $10M to modernize nurse staffing and scheduling

In 2022, Ilana Borkenstein and her Harvard Business School classmate Eric Gruskin launched M7 Health to modernize workforce management for nursing staff. The startup raised $10 million to scale its platform to more hospitals and health systems.

OpenEvidence raises $210M, unveils AI agents built for advanced medical research

Artificial intelligence startup OpenEvidence banked a $210 million series B round as it looks to expand its strategic content partnerships to build out its advanced medical knowledge library.

Elevance Health CEO Gail Boudreaux says company taking 'concrete steps' to address cost pressures

Shares in Elevance Health dipped slightly premarket as the insurer reported $1.7 billion in profit for the second quarter of 2025, falling short of Wall Street analysts' expectations.

Blue KC wrongfully denied medical diagnoses, hospital alleges in AI-driven claims lawsuit

A new lawsuit puts the use of AI by third-party vendors in denying medical diagnoses under the spotlight.
 
Fierce podcasts

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Whole health, whole new med school: Alice Walton’s vision comes to life in Arkansas

In this episode of "Podnosis," we explore how Walmart heir Alice Walton’s new medical school in Arkansas is rethinking medical education with a whole health approach that values empathy, the arts and business alongside clinical training.
 

Resources

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Cut Costs. Boost Care. Get Smart with Benefits.

Healthcare costs are soaring — but leading employers aren’t just watching. They're using data to take control. Discover how advanced analytics can unify your benefits, reveal savings, and drive better care in our latest report.

 

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