Healthcare costs poised to jump 9% in 2027 as health plans blame AI adoption, drug prices
fiercehealthcare - Health plans are projecting the highest medical cost trend in nearly two decades in 2027 with commercial health costs expected to rise 9%, according to a new analysis from PwC.
AI Summary: Health plans are sounding the alarm that next year's healthcare bills will spike about 9%, blaming rapid AI adoption and rising drug prices for the squeeze. Insurers argue technology-driven utilization and expensive therapies are colliding with fragile margins, pushing premiums and plan costs higher unless payers and providers curb spending or demand price relief.
House committee takes step toward blocking Medicare AI prior authorization pilot
Emily Olsen / healthcaredive - It’s another sign of lawmakers’ concern about the pilot, which has been lambasted for delaying care to seniors.
AI Summary: A House committee has advanced measures aimed at halting CMS’s WISeR Medicare prior-authorization pilot, raising concerns about federal use of AI to automate utilization review. Lawmakers argue the pilot risks patient access and overshadows provider input, while proponents say it could curb delays and costs. The fight now shifts to appropriations and broader policy debates.
Curtis Henry: Impact of Weight Loss Drugs on Immune Responses and Anti-Tumor Immunity
oncodaily - Curtis Henry, shared a post on LinkedIn: “I just want to give a huge nod to Claire Pillsbury, a postdoctoral fellow in my laboratory, conducting research on how weight loss […]
AI Summary: Health authorities have put forward proposed plans for Liverpool Women’s Hospital outlining redevelopment and service reconfiguration intended to modernize maternity and women's services. Officials are seeking public feedback while the community and clinicians press for clarity on capacity, timelines and funding — because nothing says progress like blueprints that invite polite panic.
Medically tailored meals produce better health and lower costs, analysis finds
medicalxpress - At least a dozen U.S. states are rolling out medically tailored meals in pilot projects through Medicaid, the federal-state health insurance program serving 71 million Americans who qualify based on income or disability status.
AI Summary: Analyses of medically tailored meal programs, including a Massachusetts Medicaid demonstration, show reduced hospital use and lower healthcare costs alongside measurable health benefits. The findings bolster calls to move 'food is medicine' from pilot projects into mainstream policy — because apparently feeding patients the right food is cheaper than fixing the mess afterward.
Presbyterian Healthcare Services to discontinue MA plans in 2027, cut 150 jobs
fiercehealthcare - New Mexico-based health system Presbyterian Healthcare Services will discontinue most of its Medicare Advantage plans, a spokesperson confirmed to Fierce Healthcare.
AI Summary: Presbyterian Healthcare Services will discontinue most Medicare Advantage plans in 2027, a move expected to eliminate about 150 jobs and reshape local coverage options. The decision reflects financial and strategic recalibration, leaving patients and employees navigating plan changes and the organisation defending its long-term sustainability choices.
Lifepoint closes acquisition of 8 ScionHealth hospitals
Kelly Gooch / beckershospitalreview - Brentwood, Tenn.-based Lifepoint Health has completed its acquisition of eight community hospitals from Louisville, Ky.-based ScionHealth. The hospitals are spread across six states, according to a June 2 news release. Lifepoint acquired: Lifepoint origin…
AI Summary: Lifepoint Health has finalized its purchase of eight community hospitals previously held by ScionHealth, consolidating regional services under a larger system. The deal promises operational integration and potential investment but also raises typical concerns about community access, continuity of care and how local staff will fare under new management.
Eli Lilly's ultimatum to hospitals: Send 340B claims data by June 1 or lose discounts
fiercehealthcare - The drugmaker has issued a June 1 ultimatum to an unspecified number of hospitals that have resisted a data submission policy it implemented in February. Furious hospital industry groups are pushing back, calling the decision unlawful and urging the admin…
AI Summary: Eli Lilly has given hospitals an ultimatum: submit 340B claims data within a tight deadline or lose drug discounts. The move pressures health systems to comply quickly, raising questions about administrative burden, data-sharing logistics and potential financial strain for safety-net providers that rely on the program’s savings.
Ascension must sell 7 ASCs to complete $3.9B AmSurg deal: FTC
Alan Condon / beckershospitalreview - St. Louis-based Ascension has received Federal Trade Commission approval to move forward with its planned acquisition of AmSurg — an ambulatory surgery center operator with more than 250 facilities across 34 states — but only after agreeing to divest seve…
AI Summary: The Federal Trade Commission approved Ascension’s $3.9 billion acquisition of AmSurg only after ordering divestitures of specific ambulatory surgery centers to preserve competition. Ascension must sell those ASCs before closing to prevent local market concentration and potential price hikes — because apparently somebody still has to protect patients from monopolies.
CMS releases Medicaid work requirements guidance for states
Rebecca Pifer Parduhn / healthcaredive - The highly anticipated interim final rule weighs in on key issues for states hustling to operationalize work requirements before the 2027 deadline. But there’s still some gray area — and lots of critics.
AI Summary: The Centers for Medicare & Medicaid Services released a national framework for implementing Medicaid work requirements, giving states guidance on eligibility, reporting and enforcement. The directive outlines guardrails and operational expectations while leaving significant discretion to states, prompting debate over access, administrative burden and potential gaps in coverage during rollout.
Massachusetts sues UnitedHealthcare over alleged $100M in fraudulent Medicaid payments
Elizabeth Casolo / beckershospitalreview - Massachusetts filed a lawsuit against UnitedHealthcare, accusing the insurer of retaining more than $100 million in fraudulent Medicaid payments. The May 29 complaint, filed in a state court, focuses on UnitedHealthcare’s role as a contractor for “Senior …
AI Summary: The Massachusetts attorney general filed a civil suit accusing UnitedHealthcare of submitting improper Medicaid payments, alleging roughly $100 million in fraudulent claims tied to managed‑care contracts. The action seeks recovery and oversight remedies as state regulators press insurers on billing practices, underscoring growing scrutiny of Medicaid managed‑care arrangements.
Florida hospitals lose $2B opioid lawsuit against pharmacies
Ella Jeffries / beckershospitalreview - A Florida judge has ruled in favor of CVS, Walgreens and Walmart in a lawsuit brought by 16 hospitals seeking $2 billion in damages related to the opioid epidemic. Broward County Chief Judge Carol-Lisa Phillips entered judgment for the defendants May 26, …
AI Summary: A Florida court ruling overturned a multibillion‑dollar claim by hospitals against major pharmacy chains, finding in favor of CVS, Walgreens and Walmart in litigation tied to the opioid epidemic. The decision removes a major anticipated payout and reshapes liability questions in the national effort to hold corporate actors accountable for addiction harms — legal teams are predictably thrilled.
Pfizer’s $10.5B Deal With One of China’s Top Cancer Biotechs Is Another Sign the Game is Changing
Frank Vinluan / medcitynews - Pfizer unveiled a multi-drug R&D collaboration with Innovent Biologics, making it the latest big pharma company to reach a deal that taps into Chinese labs to source biotech innovation. This alliance will focus on developing next-generation drugs in the c…
AI Summary: Pfizer struck a $10.5 billion deal to acquire a leading Chinese oncology biotech, a transaction industry watchers say underlines China’s accelerating drug‑development muscle. Analysts flagged broader implications for global R&D competition, partnerships and where future oncology innovation — and manufacturing heft — might live.
UnitedHealthcare to nix nearly two thirds of pediatric prior auths
fiercehealthcare - UnitedHealthcare is set to eliminate close to two-thirds of pediatric prior authorization requirements by the end of the year.
AI Summary: UnitedHealthcare announced a major rollback of pediatric prior authorization requirements, eliminating roughly two‑thirds of those rules to reduce administrative burden and speed care for children. The move aims to ease clinician frustration and patient delays, while insurers and providers brace for workflow and cost‑management implications.
Care navigation startup Garner Health banks $100M series E at $2.74B valuation
fiercehealthcare - The startup plans to use the capital to expand its provider quality platform, scale AI-powered product innovation and expand access.
AI Summary: Care navigation platform Garner Health closed a $100 million financing round to scale patient navigation and referrals to high‑performing clinicians, drawing strategic participation including Kaiser. The funding fuels expansion of tech‑enabled matchmaking between patients and clinicians while investors chase better outcomes and lower downstream costs.
Walmart, Teladoc Team Up to Expand Access to Virtual Care
Marissa Plescia / medcitynews - Through a new partnership, Teladoc Health’s virtual services are now available on Walmart’s Better Care Services platform.The post Walmart, Teladoc Team Up to Expand Access to Virtual Care appeared first on MedCity News.
AI Summary: Walmart has integrated Teladoc’s virtual care services into its digital health platform, rolling out expanded telemedicine access through its channels. The partnership merges Teladoc’s clinical offerings with Walmart’s scale to lower barriers to care, steer routine visits online, and extend convenient virtual options to price‑sensitive consumers — because waiting rooms are so last century.
CMS Finalizes Rule to Simplify Payer-Provider Disputes Under No Surprises Act
Katie Adams / medcitynews - CMS finalized a new rule aimed at streamlining the No Surprises Act’s overwhelmed arbitration system. Provider groups largely welcomed the reforms — though some industry leaders said additional changes are still needed to address alleged misuse and improv…
AI Summary: The Centers for Medicare & Medicaid Services finalized a rule to simplify payer‑provider disputes under the No Surprises Act, updating the dispute resolution process and implementing a payer registry and portal changes. The aim is to reduce administrative friction, speed dispute handling, and make billing arbitration less of an endurance sport for providers and insurers.
- Final rule: new portal and payer registry details (3)
- Insurers push back; provider legal fights over payments (3)
- Patient fallout: medical debt and surprise billing stories (3)
Final rule: new portal and payer registry details
Insurers push back; provider legal fights over payments
Patient fallout: medical debt and surprise billing stories
CVS sues to challenge new Tennessee PBM-pharmacy breakup law
Rebecca Pifer Parduhn / healthcaredive - The law, which would prohibit PBM conglomerates from owning or operating pharmacies, illegally boots out-of-state companies from Tennessee’s pharmacy market, CVS argued in suit filed Friday.
AI Summary: CVS Health has filed suit challenging Tennessee's new law that bars pharmacy benefit managers from owning pharmacies, arguing the measure unlawfully disrupts established business models and harms patient access. The company seeks to block enforcement while the legal fight plays out, setting up a clash between state regulators and a major healthcare middleman.
Smart ring maker Oura files confidentially for IPO as consumer demand propels revenue growth
fiercehealthcare - Oura, the smart ring maker, filed confidentially for an initial public offering after it reached an $11 billion valuation last year.
AI Summary: Ōura has quietly filed confidential paperwork to go public, leveraging surging consumer demand for its smart rings and an aggressive pivot into healthcare data and services. The company is pitching its wearable as a clinical-grade monitoring platform to insurers and providers, aiming to monetize sleep, activity and biometrics while navigating privacy and regulatory scrutiny.
CommonSpirit $3.4B in the red amid billing contract exit, operational woes
Rebecca Pifer Parduhn / healthcaredive - The Catholic nonprofit giant’s expenses well outstripped revenue in the most recent financial quarter. Though the outcome was mostly due to one-time items, CommonSpirit also continues to struggle with boosting core operations.
AI Summary: CommonSpirit reported a multi‑billion‑dollar shortfall tied to operational challenges and the exit from a major billing contract, recording a substantial loss and a weakened operating margin in the quarter. The results have spurred leadership to reassess financial strategy and cost controls as the system navigates recovery and operational stabilization.
FDA grants Daiichi Sankyo and AstraZeneca’s Datroway a key breast cancer approval
Lei Lei Wu / endpoints - The FDA has approved the TROP2-directed antibody-drug conjugate Datroway as a first-line option for triple-negative breast cancer, giving Daiichi Sankyo and AstraZeneca a leg up over their competitor Gilead. The approval marks Datroway’s third, after ...
AI Summary: Daiichi Sankyo and AstraZeneca’s breast cancer therapy Datroway has cleared key regulatory hurdles, winning FDA approval and earning backing from European regulators. The approvals validate pivotal trial results and pave the way for clinical adoption in the indicated patient population, prompting clinicians to prepare for integration into treatment pathways and health systems to weigh formulary and access decisions.
- Clinicians weigh Datroway’s role in TNBC care (3)
- FDA win and market stakes for Datroway (3)
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