Why the Future of IDR Depends on Smarter Technology
Focusing on fringe cases of abuse misses a more immediate and arguably more pervasive problem:…
Why the Future of IDR Depends on Smarter Technology
Focusing on fringe cases of abuse misses a more immediate and arguably more pervasive problem: many provider organizations are not getting the access to IDR they’re entitled to because the process is too difficult to navigate effectively at scale. The post Why the Future of IDR Depends on Smarter Technology appeared first on MedCity News.
What Health Systems Miss When Building National Service Lines
Clinical integration is not achieved through governance structures alone. It depends on whether the organization has developed the operational capabilities required to execute consistently across markets that historically functioned independently. The post What Health Systems Miss When Building National Service Lines appeared first on MedCity News.
Affordable Care Act Insurers Want More Premium Increases as Enrollment Sags
For the second year in a row, many Affordable Care Act insurers are proposing double-digit premium increases, driven by rising medical costs as well as policy changes by Congress and the Trump administration. In preliminary filings with state regulators, insurers are seeking a median rate increase of 14% for 2027, according to an analysis of…
Patients Face a Thicket of Red Tape Trying To Maintain Consistent Health Coverage
By the time Derion Blackman collapsed in front of a Dollar General in Kissimmee, Florida, in March, he had been waiting two months to regain access to some of the vital medications he’d been taking since undergoing a heart transplant two years ago. “He was on a nasty, dirty ground in front of a store,”…
In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year
ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third…
Healthcare and AI are in Need of Relationship Counseling
Performing well in controlled settings is only part of the picture, the harder question is whether AI is being integrated into clinical workflows in ways that keep responsibility, authority, and accountability properly aligned. The post Healthcare and AI are in Need of Relationship Counseling appeared first on MedCity News.
A ridiculously stupid letter from a health insurer
By MATTHEW HOLT It’s hard to imagine but I may now be in possession of the stupidest letter I’ve ever received from an American health insurance company–-and I’m the guy who got five identical letters on one day from Blue Shield of California telling me that they had changed my primary care doctor when I…
What are copay accumulators?
KFF reports on the increased use of copay accumulators: Oscar Health is one of many commercial health insurers that use what are often called copay accumulator programs to keep funds that are meant to defray patients’ out-of-pocket costs for expensive specialty drugs. Over the past decade, more insurers have adopted such strategies to reduce their prescription…
Ascension to Buy Tennessee Health System for Nearly $1B
Ascension is set to acquire Williamson Health, a county-owned health system in Tennessee, in a deal worth nearly $1 billion. Ascension’s offer beat out bids from HCA Healthcare and Optum. The post Ascension to Buy Tennessee Health System for Nearly $1B appeared first on MedCity News.
Elevance Sues CMS Over Star Ratings, Seeks Same Recalculation Applied to Clover
Elevance filed a lawsuit last week against the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, alleging that CMS unlawfully refused to recalculate Elevance’s 2026 Medicare Advantage Star Ratings on the same basis that it recently recalculated Clover Health’s ratings after a court ruling. The post Elevance Sues CMS…
