Pharmacy Benefit Operations Infrastructure Must Rise to Regulatory Reform Standards
The PBM reform efforts are directional, not temporary. Meeting these expectations requires automated systems that…
Pharmacy Benefit Operations Infrastructure Must Rise to Regulatory Reform Standards
The PBM reform efforts are directional, not temporary. Meeting these expectations requires automated systems that can reconstruct claim logic on demand and provide real-time alignment between pricing, rebates and financial outputs. The post Pharmacy Benefit Operations Infrastructure Must Rise to Regulatory Reform Standards appeared first on MedCity News.
988 Enters Its Fourth Year as Demand Grows and the Mental Health and Substance Use Landscape Shifts
Data as of March 2026 show that demand for 988 continues to rise, with the volume of calls, texts, and chats 15% higher than a year earlier and nearly 50% higher than two years ago. States are also answering more calls in-state, where counselors are more likely to be familiar with local resources.
3 Things to Know About Substance Use and Suicide Mortality
This brief explores substance use and suicide deaths, finding that, collectively, these deaths ranked #3 in leading causes of death in the U.S. in 2024. Trends in substance use and suicide deaths over time and by demographics are also presented.
A Roadmap to Real Healthcare AI Execution
[Sponsored] This guide is designed to help you identify the environmental constraints that matter most, then address them in a realistic sequence that fits how healthcare IT work actually gets done. The post A Roadmap to Real Healthcare AI Execution appeared first on MedCity News.
Knee Pain? Ragged Cartilage? Research Suggests Surgery’s Not the Best Answer
Thousands of Americans who undergo a common knee surgery might be making their problems worse rather than better. Researchers who followed patients for 10 years after they received either the actual procedure, arthroscopic knee surgery to trim degenerative cartilage tears, or merely “sham surgery” — a skin incision — for knee pain, found that the…
Lawmakers Look To Make Abortion Shield Laws Less Dependent on Who’s Governor
When Gov. Gavin Newsom, using his executive power, refused to extradite a physician accused of prescribing and mailing abortion pills to a Louisiana woman, he said California would “not ever” allow “extremist politicians” to punish its doctors. Newsom, who is considering a run for president, has long championed reproductive rights, but state lawmakers in the…
The AI Arms Race in Administrative Health Care
Caroline Pearson, executive director of the Peterson Health Technology Institute (PHTI) and the Peterson Center on Healthcare, joins Chip to discuss who really benefits as AI moves into health care’s back office. A quiet arms race is underway — providers deploying AI to code, bill, and capture revenue and insurers deploying it right back to…
Kaiser Nurses Protest CEO’s AHA Appearance Over AI Concerns
As Kaiser Permanente CEO Greg Adams touted the success of his organization’s value-based care models at the AHA Leadership Summit in Denver, Kaiser nurses outside protested the health system’s AI strategy. They claim they’re being excluded from decisions about the technology. The post Kaiser Nurses Protest CEO’s AHA Appearance Over AI Concerns appeared first on…
The wrong people are scared of clinical AI
By CRAIG HAUBEN Ask anyone outside healthcare who resists clinical AI and you’ll get a confident answer. The older doctors. The ones who spent thirty years building expertise and now see a machine coming for it. The story writes itself, which should have been the first clue it was wrong. I’ve spent thirty years in…
Medicaid managed care: An Explainer
A paper by Mark Shepard and Jacob Wallace (2026) has a great overview of the Medicaid managed care program. The first question one may have is, how does Medicaid managed care differ from other forms of government procurement. “In standard public procurement—such as contracting for infrastructure projects—the government specifies desired services, solicits bids, selects winners,…
