AI Made Healthcare Smarter – The Next Step is Making It Simpler

A newly diagnosed person experiences healthcare as a complicated maze of physicians, specialists, pharmacies, insurers, deductibles, formularies, prior authorizations, benefit explanations and coverage rules that rarely speak to one another and often contradict each other. Better AI can help. The post AI Made Healthcare Smarter – The Next Step is Making It Simpler appeared first…

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Women’s History Month Spotlight: Maria Tabarez

Maria Tabarez, Director of Facilities, Exodus Recovery Safe Landing Maria Tabarez has an unusual job: maintaining, cleaning, and disinfecting a 172-bed homeless shelter.  The challenges of keeping the five-building facility clean and disinfected 24/7 present challenges unlike most other Crothall facilities. Some residents who come to Exodus Recovery Safe Landing in Los Angeles have more…

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A Backlash Against Health Insurers, Redux

In this JAMA Health Forum post, Executive Vice President Larry Levitt recalls the mid-1990s’ public backlash against Health Maintenance Organizations (commonly known as HMOs) – all of which preceded the recent outpouring of health insurance concerns – as well as how consumer protections against coverage restrictions have evolved and fallen short.

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Claims Denials and Appeals in ACA Marketplace Plans in 2023

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…

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KFF Health News’ ‘What the Health?’: American Health Under Trump — Past, Present, and Future

The Host Emmarie Huetteman KFF Health News @emmarieDC Emmarie Huetteman, senior editor, oversees a team of Washington reporters, as well as “Bill of the Month” and KFF Health News’ “What the Health?” She previously spent more than a decade reporting on the federal government, most recently covering surprise medical bills, drug pricing reform, and other health policy…

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When Drug Price Transparency Isn’t Enough

By KRISTINA SMITH & PHIYEN NGUYEN Policymakers and advocates often promote drug price transparency to lower costs and improve equity. While transparency is an important first step toward accountability and informed public budgeting, it does not guarantee affordable prices or fair access to medicines. Transparency Has Some Benefits Drug price transparency helps show how and…

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