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Alliance of Community Health Plan

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uuid0009y5v

Namestring
Alliance of Community Health Plan
Legal namestring
Alliance of Community Health Plans
Websiteurl
achp.org
Company typeenum
Private
Founded yearint
1984
Descriptiontext

The Alliance of Community Health Plans (ACHP) is a nonprofit trade association founded in 1984 (originally as The HMO Group, rebranded in 2001) and headquartered in Washington, D.C. It represents 30 member organizations (29 nonprofit, regional, community-based health plans) that together cover more than 24 million lives across nearly 40 U.S. states and the District of Columbia. ACHP's core function is advocacy and convening: it lobbies federal agencies and Congress on Medicare Advantage, ACA marketplaces, drug pricing, Medicaid, and digital health; issues policy briefs, comment letters, and an annual Affordability Report; and coordinates quality-improvement programs such as the Chronic Disease Pledge (diabetes, hypertension, obesity) and the multi-year Breaking Barriers to Diabetes Care CGM Innovation Pilots. Membership programs include ACHP Connect (a member-only online community) alongside flagship convenings like the Annual Symposium, CEO Retreats, and the Joint MA Summit co-hosted with the Health Plan Alliance.

Short descriptiontext

The Alliance of Community Health Plans (ACHP) is a nonprofit trade association that advocates in Washington, D.C. for 30 nonprofit regional health plans collectively covering over 24 million lives across nearly 40 states, providing policy research, member convenings, and quality-improvement initiatives.

Operating statusenum
Operating
Ownership categoryenum
Headcount rangeband
11–50
akta.pro rankint
HeadquartersWashington, United States
HQ citystring
Washington
HQ countrystring
United States
HQ regionstring
North America
Markets served

Serves global market

Offices1 record

Each record includes

City, Country, Type, Description, Source

Keyword5 values
healthcare advocacy services, health plan association, policy research publications, member collaboration platform, chronic disease initiatives
NAICS code2 codes
  • Business Associations813910
  • Professional Organizations81392
SIC code1 code
  • Services-Membership Organizations8600
Product category
Healthcare Trade Association Services
GTM motion1 record

Each record includes

Type, Description, Source

Revenue model1 record
1Membership Dues
TypeSubscription Recurring
Description

ACHP generates revenue through annual membership dues from Select Members (nonprofit health plans, integrated delivery networks, physician-provider groups) and Affiliate Members (consulting practices and corporations supplying goods/services to community health plans).

achp.org
Marketing channels6 records

Each record includes

Title, Type, Stage, Description, Source

Distribution channels2 records

Each record includes

Title, Type, Scope, Target buyer, Description, Source

Cost components4 values
Personnel, Operations, Marketing or Sales, Others
GTM typeB2B
B2B
Offering typeServices
Services
Core offering1 text field

ACHP is a national nonprofit trade association that represents 30 community-based, nonprofit regional health plans covering over 24 million lives across nearly 40 states. It sells Select Membership to nonprofit health plans and integrated delivery networks, and Affiliate Membership to healthcare technology vendors and service providers. ACHP delivers policy advocacy, research publications (such as the annual Affordability Report), clinical innovation programs (including the Chronic Disease Pledge and CGM Innovation Pilots), and a member collaboration platform (ACHP Connect), funded by membership dues and event sponsorships.

Differentiator
Functional benefit
Problem solved
Quantifiable outcome1 of 4 values shown
  • ACHP member plans represent nearly 25% of NCQA's top-rated commercial plans
+3 more records
Product overview1 text field

The Alliance of Community Health Plans (ACHP) is a national advocacy organization representing nonprofit, regional health plans. ACHP does not offer a single unified product but rather provides a portfolio of programs, initiatives, and platforms. The core offerings include: ACHP Connect, a member-only community platform for collaboration; policy advocacy and research publications including the Affordability Report; and initiatives such as MA for Tomorrow (Medicare Advantage reform), Chronic Disease Pledge (diabetes, hypertension, obesity), Roadmap 2030, and Value-Based Care programs. ACHP Foundation supports research initiatives including the Breaking Barriers to Diabetes Care CGM Innovation Pilots. These programs work together to advance ACHP's mission of improving health care affordability and outcomes through evidence-based policy reform and member collaboration.

Product and service2 records
1Select Membership
CategoryMembership
Description

Annual membership tier for nonprofit, community-based regional health plans, integrated delivery networks, and physician-provider groups seeking federal policy advocacy, peer collaboration, and quality benchmarking.

2Affiliate Membership
Scale indicator9 records

Each record includes

Type, Value, Description, Source

Partnership13 partners
Strategic tierCoreTypeStrategic or Co-development Partner
Description

Abbott is a global healthcare leader in cardiovascular care, diabetes management, and diagnostic testing. Through partnership with ACHP, Abbott raises awareness for chronic disease prevention and CGM accessibility. Main contact: Courtney Veasy, Director, Regional Accounts.

Strategic tierCoreTypeStrategic or Co-development Partner
Description

Epic is a leading health-informatics firm renowned for comprehensive electronic health record systems, powering care delivery across top hospitals and handling records for over 300 million patients. Main contact: Patrick Schenk, Vice President.

Strategic tierMinorTypeStrategic or Co-development Partner
Description

Verily is a data platform and technology company purpose-built to power AI for precision health, offering AI-enabled solutions that transform multimodal health data into insights. Main contact: Jeff Marwill, Vice President.

Strategic tierMinorTypeStrategic or Co-development Partner
Description

Zelis modernizes the healthcare financial experience with a connected platform serving over 700 payers, millions of providers and consumers. Main contact: Colin Hadican, Senior Vice President of Sales.

Strategic tierMinorTypeStrategic or Co-development Partner
Description

Navitus is a transparent PBM model alternative to traditional PBMs, committed to removing cost from the drug supply chain. Main contact: Kevin Engelien, Senior Director, Health Plan Strategy.

Strategic tierMinorTypeStrategic or Co-development Partner
Description

mPulse combines predictive analytics and digital experience technology to improve efficiency and advance equitable health outcomes at scale, serving over 400 healthcare organizations. Main contact: Nora Cristobal, Programs Marketing Manager.

Strategic tierMinorTypeStrategic or Co-development Partner
Description

Protera Health provides affordable, virtual multidisciplinary care for musculoskeletal (MSK) conditions to help health plans contain rising costs while improving member health. Main contact: Eric C. Makhni, MD, Founder and CEO.

Strategic tierMinorTypeStrategic or Co-development Partner
Description

Ikigai Venture Partners works with venture capital groups and entrepreneurial leadership teams to accelerate growth of innovative early-stage healthcare technology companies. Main contact: Michael Brouthers, Principal & Managing Director.

Strategic tierMinorTypeStrategic or Co-development Partner
Description

MacroHealth provides an Intelligent Health Market as a Service platform that helps payers, providers and market partners optimize and connect their healthcare ecosystems. Main contact: Aarti Karamchandani, Chief Growth Officer.

Strategic tierMinorTypeStrategic or Co-development Partner
Description

Epicured is a nutrition-solutions company founded to translate medical research into high-quality nutrition delivered fresh nationwide, developing nutritional products to improve lives and lower healthcare costs. Main contact: Richard Bennet, Founder.

Strategic tierMinorTypeStrategic or Co-development Partner
Description

Rx Savings Solutions provides a web-based healthcare consumerism software helping employers, employees and health plans save money on prescription medications. Main contact: Sheena Desai, Marketing Manager, Health Plans.

Strategic tierCoreTypeStrategic or Co-development Partner
Description

ACHP is hosting the Paying for Obesity Care national forum in partnership with NASEM in November 2026 to examine how obesity care can move beyond medication-centric models toward sustainable, lifestyle-driven approaches.

Strategic tierCoreTypeStrategic or Co-development Partner
Description

ACHP and Health Plan Alliance co-host the Joint MA Summit bringing together leaders from both organizations' member plans. Together they represent more than 60 nonprofit, provider-sponsored health plans.

Recent move6 records

Each record includes

Date, Type, Title, Description, Source

Expansion highlight6 records

Each record includes

Type, Description

Peers10 records
TypeBroad incumbent
Description

AHIP is the largest U.S. health insurance trade association, representing payers across commercial, Medicare, and Medicaid markets. ACHP is comparable as a peer health plan trade association but differentiates by focusing exclusively on nonprofit, community-based regional plans.

TypeDirect peer
Description

Health Plan Alliance is a membership organization for nonprofit, provider-sponsored health plans. ACHP explicitly co-hosts the Joint MA Summit with this organization, and both serve overlapping populations of nonprofit regional plans with comparable advocacy and collaboration mandates.

TypeDirect peer
Description

MHPA is a trade association representing Medicaid managed care plans. It is a direct peer to ACHP in that both advocate for health plans serving government-program populations, and several ACHP member plans are also active in Medicaid.

TypeBroad incumbent
Description

BCBSA is the national federation of Blue Cross and Blue Shield plans, the largest U.S. health plan network. It is a broad-incumbent peer because, like ACHP, it represents multiple regional plans and conducts federal advocacy, but it serves for-profit and nonprofit licensee plans at much greater scale.

TypeDirect peer
Description

America's Physician Groups is a trade association for provider-owned, risk-bearing medical groups. It is comparable to ACHP because both serve provider-integrated organizations operating under value-based, capitated payment models in regional markets.

6American Medical Group Association (AMGA)
TypeBroad incumbent
Description

AMGA represents large multispecialty medical groups and integrated delivery systems. It overlaps with ACHP's integrated delivery network membership tier and shares the value-based care and population-health agenda.

7National Association of ACOs (NAACOS)
TypeEmerging player
Description

NAACOS is a membership organization for accountable care organizations, including many provider-sponsored entities. It is comparable to ACHP as a value-based care advocacy organization with overlapping members among ACOs and provider-led plans.

TypeDirect peer
Description

National Business Group on Health is a membership organization of large employers that purchases health benefits and advocates for value-based care. It is comparable to ACHP because both convene purchasers/plans around affordability, quality measurement, and policy reform.

TypeEmerging player
Description

Catalyst for Payment Reform is a nonprofit focused on payment reform and value-based purchasing. It is comparable to ACHP because both organizations push the U.S. health system away from fee-for-service toward value-based payment models.

TypeDirect peer
Description

Alliance for Health Policy is a nonpartisan nonprofit that convenes stakeholders on health policy issues. It is comparable to ACHP because both operate from Washington, D.C., produce health policy research, and convene payers, providers, and policymakers.

Market position
Strengths4 records

Each record includes

Headline, Details, Source

Weaknesses4 records

Each record includes

Headline, Details, Source

Competitive moat5 records

Each record includes

Type, Details

Key risks6 records

Each record includes

Headline, Details, Source

Key highlights7 records

Each record includes

Headline, Details, Source

Customer concentration

Classification, Details

Named customers8 records

Each record includes

Name, Industry, Type, Use case, Source, UUID

Segment3 records

Each record includes

Title, Type, Primary, Description, Pain point addressed, Use case, Source

Ideal customer profile3 records

Each record includes

Profile, Firmographic size, Sales motion, Sales cycle length, Buying structure, Purchase trigger, Buyer persona, Geography, Industry vertical, Primary use case, Description, Pain points, Evidence proof points, Target buyer

Technology focused
No
API detail
Has APIbool
No

Docs URL, Description

AI maturity
App detail

Has app

Core technology
Revenue estimate
Valuation estimate
Number of profiles
Profiles17 records

Each record includes

Name, Designation, Designation category, Overview, Profile commentary, Source

No data
No data
Funding overview

Funding stage, Last funding date, Total funding USD

Funding rounds1 record

Each record includes

Round, Amount USD, Date, Pre money valuation, Total investors, Investors, News

Investors1 record

Each record includes

Name, Type, Date of entry, Rounds participated, Website

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Each record includes

Name, Acquisition type, Announced date, Completed date, Status, Website, News

Investment

Each record includes

Name, Round, Announced date, Lead investor, Website, News

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Alliance of Community Health Plan

Healthcare Trade Association Servicesachp.org

The Alliance of Community Health Plans (ACHP) is a nonprofit trade association that advocates in Washington, D.C. for 30 nonprofit regional health plans collectively covering over 24 million lives across nearly 40 states, providing policy research, member convenings, and quality-improvement initiatives.

What Alliance of Community Health Plan does

The Alliance of Community Health Plans (ACHP) is a nonprofit trade association founded in 1984 (originally as The HMO Group, rebranded in 2001) and headquartered in Washington, D.C. It represents 30 member organizations (29 nonprofit, regional, community-based health plans) that together cover more than 24 million lives across nearly 40 U.S. states and the District of Columbia. ACHP's core function is advocacy and convening: it lobbies federal agencies and Congress on Medicare Advantage, ACA marketplaces, drug pricing, Medicaid, and digital health; issues policy briefs, comment letters, and an annual Affordability Report; and coordinates quality-improvement programs such as the Chronic Disease Pledge (diabetes, hypertension, obesity) and the multi-year Breaking Barriers to Diabetes Care CGM Innovation Pilots. Membership programs include ACHP Connect (a member-only online community) alongside flagship convenings like the Annual Symposium, CEO Retreats, and the Joint MA Summit co-hosted with the Health Plan Alliance.

Alliance of Community Health Plan firmographics

Firmographics
Name
Alliance of Community Health Plan
Legal name
Alliance of Community Health Plans
Website
https://achp.org
Company type
Private
Founded year
1984
Operating status
Operating
Headcount range
11–50 employees
Short description
The Alliance of Community Health Plans (ACHP) is a nonprofit trade association that advocates in Washington, D.C. for 30 nonprofit regional health plans collectively covering over 24 million lives across nearly 40 states, providing policy research, member convenings, and quality-improvement initiatives.
Ownership category
akta.pro rank

Where Alliance of Community Health Plan is headquartered

Location

Headquarters

HQ city
Washington
HQ country
United States
HQ region
North America

Offices1 record

Markets served

Alliance of Community Health Plan business model

Business model
GTM type
B2B
Offering type
Services
Cost components
Personnel, Operations, Marketing or Sales, Others

Revenue model

  1. Membership Dues: ACHP generates revenue through annual membership dues from Select Members (nonprofit health plans, integrated delivery networks, physician-provider groups) and Affiliate Members (consulting practices and corporations supplying goods/services to community health plans).

Go-to-market motion1 record

Distribution channels2 records

Marketing channels6 records

Alliance of Community Health Plan product offering

Product offering

Core offering

ACHP is a national nonprofit trade association that represents 30 community-based, nonprofit regional health plans covering over 24 million lives across nearly 40 states. It sells Select Membership to nonprofit health plans and integrated delivery networks, and Affiliate Membership to healthcare technology vendors and service providers. ACHP delivers policy advocacy, research publications (such as the annual Affordability Report), clinical innovation programs (including the Chronic Disease Pledge and CGM Innovation Pilots), and a member collaboration platform (ACHP Connect), funded by membership dues and event sponsorships.

Product overview

The Alliance of Community Health Plans (ACHP) is a national advocacy organization representing nonprofit, regional health plans. ACHP does not offer a single unified product but rather provides a portfolio of programs, initiatives, and platforms. The core offerings include: ACHP Connect, a member-only community platform for collaboration; policy advocacy and research publications including the Affordability Report; and initiatives such as MA for Tomorrow (Medicare Advantage reform), Chronic Disease Pledge (diabetes, hypertension, obesity), Roadmap 2030, and Value-Based Care programs. ACHP Foundation supports research initiatives including the Breaking Barriers to Diabetes Care CGM Innovation Pilots. These programs work together to advance ACHP's mission of improving health care affordability and outcomes through evidence-based policy reform and member collaboration.

Differentiator

Problem solved

Functional benefit

Products and services

  • Select Membership Annual membership tier for nonprofit, community-based regional health plans, integrated delivery networks, and physician-provider groups seeking federal policy advocacy, peer collaboration, and quality benchmarking.
  • Affiliate Membership

Quantifiable outcome

  • ACHP member plans represent nearly 25% of NCQA's top-rated commercial plans
  • +3 more outcomes

Companies that use Alliance of Community Health Plan

Customer profile

Named customers8 records

Segments3 records

Ideal customer profiles3 records

Alliance of Community Health Plan technology and API

Technology

Technology focussed No

API detail

Has API
No
API docs
API detail

Core technology

AI maturity

App detail

Alliance of Community Health Plan partnerships and signals

Strategic signal

Partnerships

13 partnerships are on record, tiered core and minor.

  • AbbottcoreStrategic or Co-development PartnerAbbott is a global healthcare leader in cardiovascular care, diabetes management, and diagnostic testing. Through partnership with ACHP, Abbott raises awareness for chronic disease prevention and CGM accessibility. Main contact: Courtney Veasy, Director, Regional Accounts.
  • Epic SystemscoreStrategic or Co-development PartnerEpic is a leading health-informatics firm renowned for comprehensive electronic health record systems, powering care delivery across top hospitals and handling records for over 300 million patients. Main contact: Patrick Schenk, Vice President.
  • VerilyminorStrategic or Co-development PartnerVerily is a data platform and technology company purpose-built to power AI for precision health, offering AI-enabled solutions that transform multimodal health data into insights. Main contact: Jeff Marwill, Vice President.
  • ZelisminorStrategic or Co-development PartnerZelis modernizes the healthcare financial experience with a connected platform serving over 700 payers, millions of providers and consumers. Main contact: Colin Hadican, Senior Vice President of Sales.
  • NavitusminorStrategic or Co-development PartnerNavitus is a transparent PBM model alternative to traditional PBMs, committed to removing cost from the drug supply chain. Main contact: Kevin Engelien, Senior Director, Health Plan Strategy.
  • mPulseminorStrategic or Co-development PartnermPulse combines predictive analytics and digital experience technology to improve efficiency and advance equitable health outcomes at scale, serving over 400 healthcare organizations. Main contact: Nora Cristobal, Programs Marketing Manager.
  • Protera HealthminorStrategic or Co-development PartnerProtera Health provides affordable, virtual multidisciplinary care for musculoskeletal (MSK) conditions to help health plans contain rising costs while improving member health. Main contact: Eric C. Makhni, MD, Founder and CEO.
  • Ikigai Venture PartnersminorStrategic or Co-development PartnerIkigai Venture Partners works with venture capital groups and entrepreneurial leadership teams to accelerate growth of innovative early-stage healthcare technology companies. Main contact: Michael Brouthers, Principal & Managing Director.
  • MacroHealthminorStrategic or Co-development PartnerMacroHealth provides an Intelligent Health Market as a Service platform that helps payers, providers and market partners optimize and connect their healthcare ecosystems. Main contact: Aarti Karamchandani, Chief Growth Officer.
  • EpicuredminorStrategic or Co-development PartnerEpicured is a nutrition-solutions company founded to translate medical research into high-quality nutrition delivered fresh nationwide, developing nutritional products to improve lives and lower healthcare costs. Main contact: Richard Bennet, Founder.
  • Rx Savings SolutionsminorStrategic or Co-development PartnerRx Savings Solutions provides a web-based healthcare consumerism software helping employers, employees and health plans save money on prescription medications. Main contact: Sheena Desai, Marketing Manager, Health Plans.
  • National Academies of Sciences, Engineering and Medicine (NASEM)coreStrategic or Co-development PartnerACHP is hosting the Paying for Obesity Care national forum in partnership with NASEM in November 2026 to examine how obesity care can move beyond medication-centric models toward sustainable, lifestyle-driven approaches.
  • Health Plan AlliancecoreStrategic or Co-development PartnerACHP and Health Plan Alliance co-host the Joint MA Summit bringing together leaders from both organizations' member plans. Together they represent more than 60 nonprofit, provider-sponsored health plans.

Scale indicators9 records

Recent moves6 records

Expansion highlights6 records

Alliance of Community Health Plan competitors and assessment

Company assessment

Broad incumbents

  • AHIP (America's Health Insurance Plans): AHIP is the largest U.S. health insurance trade association, representing payers across commercial, Medicare, and Medicaid markets. ACHP is comparable as a peer health plan trade association but differentiates by focusing exclusively on nonprofit, community-based regional plans.
  • Blue Cross Blue Shield Association: BCBSA is the national federation of Blue Cross and Blue Shield plans, the largest U.S. health plan network. It is a broad-incumbent peer because, like ACHP, it represents multiple regional plans and conducts federal advocacy, but it serves for-profit and nonprofit licensee plans at much greater scale.
  • American Medical Group Association (AMGA): AMGA represents large multispecialty medical groups and integrated delivery systems. It overlaps with ACHP's integrated delivery network membership tier and shares the value-based care and population-health agenda.

Direct peers

  • Health Plan Alliance: Health Plan Alliance is a membership organization for nonprofit, provider-sponsored health plans. ACHP explicitly co-hosts the Joint MA Summit with this organization, and both serve overlapping populations of nonprofit regional plans with comparable advocacy and collaboration mandates.
  • Medicaid Health Plans of America: MHPA is a trade association representing Medicaid managed care plans. It is a direct peer to ACHP in that both advocate for health plans serving government-program populations, and several ACHP member plans are also active in Medicaid.
  • America's Physician Groups: America's Physician Groups is a trade association for provider-owned, risk-bearing medical groups. It is comparable to ACHP because both serve provider-integrated organizations operating under value-based, capitated payment models in regional markets.
  • National Business Group on Health: National Business Group on Health is a membership organization of large employers that purchases health benefits and advocates for value-based care. It is comparable to ACHP because both convene purchasers/plans around affordability, quality measurement, and policy reform.
  • Alliance for Health Policy: Alliance for Health Policy is a nonpartisan nonprofit that convenes stakeholders on health policy issues. It is comparable to ACHP because both operate from Washington, D.C., produce health policy research, and convene payers, providers, and policymakers.

Emerging players

  • National Association of ACOs (NAACOS): NAACOS is a membership organization for accountable care organizations, including many provider-sponsored entities. It is comparable to ACHP as a value-based care advocacy organization with overlapping members among ACOs and provider-led plans.
  • Catalyst for Payment Reform: Catalyst for Payment Reform is a nonprofit focused on payment reform and value-based purchasing. It is comparable to ACHP because both organizations push the U.S. health system away from fee-for-service toward value-based payment models.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

Alliance of Community Health Plan social profiles

Digital presence

Alliance of Community Health Plan financial estimates

Financial estimate

Revenue estimate

Valuation estimate

Alliance of Community Health Plan leadership team

Management profile

Number of profiles

Profiles17 records

Alliance of Community Health Plan funding detail

Funding detail

Funding overview

Funding rounds1 record

Investors1 record

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

Alliance of Community Health Plan M&A and investment

M&A and investment

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Alliance of Community Health Plan

What does Alliance of Community Health Plan do?

ACHP is a national nonprofit trade association that represents 30 community-based, nonprofit regional health plans covering over 24 million lives across nearly 40 states. It sells Select Membership to nonprofit health plans and integrated delivery networks, and Affiliate Membership to healthcare technology vendors and service providers. ACHP delivers policy advocacy, research publications (such as the annual Affordability Report), clinical innovation programs (including the Chronic Disease Pledge and CGM Innovation Pilots), and a member collaboration platform (ACHP Connect), funded by membership dues and event sponsorships.

Is Alliance of Community Health Plan a public or private company?

Alliance of Community Health Plan is a private company. It is classified as nonprofit foundation owned and is currently operating.

When was Alliance of Community Health Plan founded?

Alliance of Community Health Plan was founded in 1984. It employs 11 to 50 people.

Where is Alliance of Community Health Plan based?

Alliance of Community Health Plan is headquartered in Washington, United States, in the North America region.

How does Alliance of Community Health Plan make money?

One revenue line is on record: membership Dues.

Who are Alliance of Community Health Plan's main competitors?

Broad incumbents on record are AHIP (America's Health Insurance Plans), Blue Cross Blue Shield Association and American Medical Group Association (AMGA). Direct peers are Health Plan Alliance, Medicaid Health Plans of America, America's Physician Groups, National Business Group on Health and Alliance for Health Policy. Emerging players are National Association of ACOs (NAACOS) and Catalyst for Payment Reform.

Does Alliance of Community Health Plan have an API?

No public API is recorded for Alliance of Community Health Plan.

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Live signals
MedCity NewsConstant Vigilance is the Watchword for Healthcare AI GovernanceA webinar moderated by MedCity News Editor-in-Chief Arundhati Parmar discussed the Healthcare AI Readiness Index, with panelists from Cotiviti and the Alliance of Community Health Plans. They emphasized that AI governance must begin before deployment and evolve with use cases, requiring constant vigilance and human oversight. The discussion also covered challenges like shadow AI and cybersecurity controls.MedCity NewsHospital and Payer AI Governance Is at a CrossroadsCotiviti and the Alliance of Community Health Plans will host a webinar on September 30 to discuss AI governance and vendor risk in healthcare. The event will feature findings from Cotiviti and MedCity News's Healthcare AI Readiness Index, covering topics like generative AI policies and human review requirements.MedCity NewsHow Payers and Health Plans Think of Identity and the Risks of Fragmented DataPanelists from SCAN Health Plan and the Alliance of Community Health Plans discussed the challenges of identity management and data fragmentation in healthcare during a webinar sponsored by Verato. They emphasized the necessity of implementing Enterprise Master Person Index (EMPI) systems to accurately link patient identities with clinical histories and caregiver relationships. The discussion highlighted how resolving these identity issues is critical for improving AI readiness and operational efficiency.MedCity NewsPayers Who Improve Data Quality Will Define the Next Era of Health Plan PerformanceMedCity News is promoting a sponsored webinar scheduled for July 22 focused on health plan data quality challenges, with executives from Verato, SCAN Health Plan, and the Alliance of Community Health Plans serving as panelists. The webinar will examine how payer data fragmentation affects member experience, AI readiness, payment accuracy, and operational efficiency. Panelists will discuss practical steps health plan leaders can take to develop trusted data foundations connecting members, providers, and organizational relationships.PR NewswireACHP Forms Patient Advisory Council to Elevate Patient Voices in Chronic Disease ResearchThe Alliance of Community Health Plans (ACHP) has launched a Patient Advisory Council to incorporate patient perspectives into chronic disease research, comprising people with diabetes, caregivers and community advocates. The council will guide ACHP's research priorities, define meaningful outcomes and ensure findings reflect the full context of patients' lives including financial, cultural and mental health considerations. The initiative was funded through a Eugene Washington PCORI Engagement Award and aligns with ACHP's mission to improve care for Americans across its member health plans in 46 states and D.C.MorningstarACHP Forms Patient Advisory Council to Elevate Patient Voices in Chronic Disease ResearchThe Alliance of Community Health Plans launched a Patient Advisory Council to incorporate patient perspectives into chronic disease research. The council, comprising people with diabetes, caregivers, and advocates, will guide research priorities and engagement. It was funded by a PCORI Engagement Award.PR NewswireBetter Care and Lower Costs: The Provider-Aligned Model of CareThe Alliance of Community Health Plans (ACHP) released its 2026 Report on Affordability in Health Care, highlighting how integrated payer-provider care models deliver better health outcomes at lower costs compared to traditional fee-for-service approaches. The report features specific achievements by ACHP member plans, including prevented hospitalizations, reduced emergency room visits, and documented savings ranging from hundreds of thousands to millions of dollars per organization. The findings are being promoted to policymakers as midterm elections approach, positioning integrated care as a solution to rising healthcare costs.FierceHealthcarePayers, hospitals pan CMS' plan to bring non-network plans to ACA exchangesCMS under the Trump administration proposed a rule to allow non-network health plans to obtain Qualified Health Plan (QHP) status on ACA exchanges for plan year 2027, aiming to lower costs through increased competition and reduced administrative overhead. In an unusually unified stance, major payer groups (AHIP, Association for Community Affiliated Plans, Alliance of Community Health Plans) and hospital groups (Federation of American Hospitals, America's Essential Hospitals, American Hospital Association) submitted joint and separate comments in March 2025 opposing the proposal, warning it would expose enrollees to unexpected out-of-pocket costs and destabilize the individual insurance market by drawing healthier enrollees away from comprehensive plans.San Bernardino SunRed and blue states alike want to limit AI in insurance. Trump wants to limit the statesMultiple states including Arizona, Maryland, Nebraska, Texas, Illinois, and California have enacted or are pursuing legislation to limit how health insurers use AI for claims denials and prior authorization, with bipartisan public concern driving the effort despite insurers' pushback. The Trump administration issued a December executive order attempting to preempt state AI regulations, arguing that restrictions would hinder U.S. competitiveness in AI innovation. Major insurers including Cigna and UnitedHealth Group testified before Congress amid lawsuits over their claims-denial practices, while industry trade groups AHIP and the Alliance of Community Health Plans oppose the patchwork of state regulations.AchpACHP and Helmsley Charitable Trust Partner to Expand Diabetes Device Access Through $4.2 Million GrantThe Alliance of Community Health Plans (ACHP) Foundation and The Leona M. and Harry B. Helmsley Charitable Trust have launched a $4.2 million, three-year grant to expand access to continuous glucose monitors (CGM) for people living with insulin-requiring diabetes. Five pilot projects will launch in October 2025 across four member health plans in Michigan, Minnesota, Utah, and Pennsylvania, testing innovative payer-led strategies to reduce barriers to CGM coverage and adoption. The partnership aims to generate real-world evidence on clinical outcomes and financial sustainability to build the case for long-term coverage policy changes recognizing CGM as a standard of care.