The settlement demonstrates that enforcement risk is real and substantial, but it also highlights an opportunity. Medicare Advantage oversight does not require years of new rulemaking or experimental pilots because the technical capability to validate documentation at scale already exists and can be deployed today. The post The Kaiser Settlement Should End the Guesswork in…
[Sponsored] A new eBook published by MedCity News for PurpleLab highlights how RWD and SDOH can lead to more inclusive clinical trials and drugs that improve the quality of life for larger, diverse patient populations not only for NSCLC, but other conditions as well. The post Using Real World Data from the Patient Experience to…
MINNEAPOLIS — Gabi has big brown eyes, pigtails, and a genetic condition that makes her bones brittle. They fracture easily, leaving the 2-year-old in such pain that her mother quit her job cleaning offices to stay home and cradle her in the one-bedroom apartment they share with six relatives. When federal immigration agents descended on…
MINNEAPOLIS. — Gabi tiene grandes ojos color café, trenzas y una afección genética que hace que sus huesos sean frágiles. Se fracturan con facilidad, lo que le provoca a la niña de 2 años tanto dolor que su madre dejó su trabajo limpiando oficinas para quedarse en casa y cargarla por el apartamento de una…
OTTUMWA, Iowa — Leisa and Kent Walker recently received a disturbing notice: The private company managing their son’s Medicaid coverage intends to cut nearly 40% of what it spends for caregivers who help him live at home instead of in a nursing home. Sam Walker, 35, has severe autism and other disabilities. He is deaf…
LISTEN: Can’t afford health insurance this year? Don’t be afraid to talk to your doctor about money and the cost of care. On WAMU’s “Health Hub” on March 4, KFF Health News correspondent Sam Whitehead shared tips for people seeking affordable options without skipping care. Health insurance could be out of reach for many Americans…
By BRIAN JOONDEPH Image created by/using ChatGPT Artificial intelligence is quickly becoming a core part of healthcare operations. It drafts clinical notes, summarizes patient visits, flags abnormal labs, triages messages, reviews imaging, helps with prior authorizations, and increasingly guides decision support. AI is no longer just a side experiment in medicine; it is becoming a…
Treating serious mental illness is not just a good thing to do for altruistic reasons. It also can improve health outcomes and reduce cost for those with comorbid physical conditions as well. Vincent Joralemon writes in Health Affairs Forefront regarding this issue. The article quotes Sherry Rais, CEO of Enthea: Ten percent of patients drive…
Contract negotiations between Mount Sinai and Anthem Blue Cross Blue Shield broke down this week, leaving the health system completely out of Anthem’s insurance network. The dispute reflects broader pressures on payers and providers, with rising costs and administrative inefficiencies driving contentious contract battles and highlighting the need for deeper cost-control innovation. The post Mount…
Webinar addresses innovative approaches to improve member outcomes in underserved communities