Claims Denials and Appeals in ACA Marketplace Plans in 2024
This brief analyzes federal transparency data published by CMS on claims denials and appeals for…
Claims Denials and Appeals in ACA Marketplace Plans in 2024
This brief analyzes federal transparency data published by CMS on claims denials and appeals for Marketplace plan offered on HealthCare.gov in 2024, and finds insurers denied 19% of in-network claims. Consumers rarely appeal denied claims.
Virtual Specialty Care Has Time. Will We Use It Wisely?
The specialty access and capacity crisis demands more than incremental fixes. It requires expanding virtual access and fundamentally rethinking how specialty care can be delivered. The post Virtual Specialty Care Has Time. Will We Use It Wisely? appeared first on MedCity News.
AI Won’t Replace Clinical Trial Teams, But It Fixes the Bottlenecks That Keep Patients Out
We don’t have a shortage of willing patients — instead we have a shortage of scalable ways to identify and engage them responsibly. AI, used meaningfully offers a reliable path forward. The post AI Won’t Replace Clinical Trial Teams, But It Fixes the Bottlenecks That Keep Patients Out appeared first on MedCity News.
What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid
This brief describes current coverage of GLP-1s in Medicare and Medicaid, the Centers for Medicare & Medicaid Services’ (CMS) efforts to expand access and lower costs for GLP-1s through temporary demonstration programs including the BALANCE Model, and potential impacts on beneficiaries and program budgets.
Assault on Scientific Integrity Is “Fundamentally Problematic.”
By MIKE MAGEE This past week, U.S. District Court Judge Judge Brian E. Murphy, dealt Trump and RFK Jr. a severe blow. Not mincing word, he voided HHS vaccine schedule changes and labeled the action an assault on scientific integrity that was “fundamentally problematic.” In early December, 2025, President Trump directed HHS Secretary Robert Kennedy…
“Me engañaron”: agentes encadenan a un padre que había ido al ICE a reunirse con sus hijos
En diciembre, Carlos llegó a una oficina del Servicio de Inmigración y Control de Aduanas (ICE) en Nuevo Mexico creyendo que estaba a un paso de reunirse con sus hijos. En ese momento, su hijo de 14 años y su hija de 16 llevaban casi un año en un albergue federal en Texas después de…
‘They Tricked Me’: A Father Was Chained After He Went to ICE To Reunite With His Kids
Carlos arrived at an Immigration and Customs Enforcement office in New Mexico in December, believing he was one step closer to reuniting with his children. By that point, his 14-year-old son and 16-year-old daughter had been in a federal shelter in Texas for nearly a year after crossing the border to be with him. “I…
Mario Danek, QNovia
Mario Danek is CEO of QNovia, a behavior change platform focusing on smoking cessation product. Essentially the problem with smoking cessation nicotine products is that they don’t deliver the “hit” of a cigarette as quickly as a cigarette or a vape. Mario’s new vape-like product delivers a nicotine replacement therapy (think like Nicorette gum) just…
The rising cost of mental illness
From a Mark et al. (2026) paper published in Health Affairs last week: …from 2000 through 2021, mental health and SUD nominal spending grew from $40.9 billion to $139.6 billion. Mental health and SUD accounted for 4.5 percent of all medical services spending in 2000 and 5.5 percent in 2021. Real per capita mental health and SUD spending grew…
Why Pure DTC Doesn’t Work in Healthcare, Per Muse Capital
Rachel Springate, general partner at Muse Capital, said the next wave of healthcare startups will be driven by consumer demand — but pure direct-to-consumer models rarely work. Companies like Midi Health, Mavida Health and Mahmee are showing a different path: starting with patients, collecting outcomes data, and integrating with clinicians, payers and the broader healthcare…
