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November 12, 2026

Takeaways from the most recent news in the technology and policies shaping healthcare.

Payers

Providence to Fully Exit Insurance Business as MA Deal Fails

Providence plans to completely shut down Providence Health Plan after it could not reach a deal with a national insurer to operate its Medicare Advantage business, the health system told Becker's Hospital Review. "We are in discussion with regulators about this development and the broader wind-down of Providence's health plan operations," a spokesperson said, adding that more details would follow.

The move caps a difficult stretch for provider-owned insurance. Running a health plan requires scale, capital, and actuarial expertise that many hospital systems struggle to sustain, especially in Medicare Advantage. Rising medical costs, tighter federal payment and audit rules, and pressure on star ratings have squeezed margins across the program, prompting even large national insurers to trim MA offerings.

For Providence, exiting lets the system refocus on its core hospital and clinical operations. Members will need to find new coverage, and regulators will oversee an orderly wind-down. The decision signals that owning a payer is no longer a clear strategic win for many integrated systems.

More in Payers

Payers

Hospitals Split on Owning Health Plans as Systems Exit

Several large health systems have sold or closed their insurance arms in the past two years, exposing a widening divide over whether providers should own health plans.

Why it matters: Whether a hospital owns an insurer shapes its revenue, risk, and leverage against payers, making it one of the defining strategic bets in healthcare.

Payers

Humana, Athenahealth Expand Electronic Prior Authorization

Humana and Athenahealth are scaling electronic prior authorization across 180,000-plus clinicians, with most September transactions requiring no manual staff work.

Why it matters: Prior authorization is a leading driver of provider burnout and administrative cost, and automation embedded in the EHR is how new federal mandates get put into practice.

Payers

How Health Plans Tell If Their Payment Ops Can Scale

Health plans can gauge whether their payment operations can truly scale by watching exception volume, return rates, and digital payment share as transaction counts rise.

Why it matters: Payment infrastructure that fails under growth drives up administrative costs and strains provider relationships just as a plan expands.