This brief analyzes federal transparency data released by the Centers for Medicare and Medicaid Services (CMS) on claims denials and appeals for non-group qualified health plans (QHPs) offered on HealthCare.gov in 2023. It finds that HealthCare.gov insurers denied nearly one out of every five claims (19%) submitted for in-network services. Information about the reasons for…
Kirk Vartan pays more than $2,000 a month for a high-deductible health insurance plan from Blue Shield on Covered California, the state’s Affordable Care Act marketplace. He could have selected a cheaper plan from a different provider, but he wanted one that includes his wife’s doctor. “It’s for the two of us, and we’re not…
The Trump administration has launched investigations into health care organizations in an effort to allow providers to refuse care for transgender patients on religious or moral grounds. One of the most recent actions by the Department of Health and Human Services, launched in mid-June, targets the University of Michigan Health system over a former employee’s…
The Host Julie Rovner KFF Health News @jrovner Read Julie’s stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to…
When we talk about post-traumatic stress disorder (PTSD), a condition fundamentally born from overwhelming experiences that leave a long-term imprint on the body, our mainstream approach often feels stuck in the past. The post The $232 Billion Problem: The Price of Overlooking the Impact of Trauma in the U.S. appeared first on MedCity News.
Healthcare doesn’t reward shortcuts. It rewards outcomes. AI will play a critical role in shaping those outcomes — but only if leaders measure what truly matters. The best AI implementations elevate expertise, improve quality and create space for innovation. The post How Smarter Metrics Can Unlock AI’s Potential in Healthcare appeared first on MedCity News.
Novartis is paying $120 million up front to secure rights to a Monte Rosa molecular glue degrader drug candidate as well as options for two others. The two companies began working together last year under an alliance focused on immune mediated-diseases. The post Novartis Adds to Its Immunology Prospects With Another Deal for Monte Rosa’s…
In 2013, before the Affordable Care Act helped millions get health insurance, California’s Placer County provided limited health care to some 3,400 uninsured residents who couldn’t afford to see a doctor. For several years, that number has been zero in the predominantly white, largely rural county stretching from Sacramento’s eastern suburbs to the shores of…
By OWEN TRIPP For decades, quality in healthcare has been defined on industry terms — not people’s terms. New technology and innovative health plan designs are finally changing that. People know quality when they see it, and they are definitely not seeing it in healthcare. Fifty-six percent of Americans rate the quality of care as…
We need apps that have been tested with real users to ensure they are intuitive and easy to use. The apps also need to be designed to be inclusive of different needs including patients with disabilities, different levels of tech literacy, and diverse needs. The post Building Patient Trust in Digital Health Software appeared first…