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Behavioral health is an integral component of comprehensive healthcare, yet the sector continues to face unique challenges that demand thoughtful solutions. From navigating complex regulatory requirements to integrating cutting-edge technologies, behavioral health payers are under constant pressure ...
4 Jun, 2025
The Centers for Medicare & Medicaid Services (CMS) is in the early stages of exploring reforms aimed at creating more uniform prior authorization policies across health insurance plans. Among the innovations being considered is the incorporation of automation into coverage determinations, a developm...
20 May, 2025
Population Health Management (PHM) has emerged as an essential strategy in healthcare, empowering organizations to improve outcomes and reduce costs while catering to the unique needs of diverse populations. Health plans aiming to meet these increasing demands are turning toward NCQA prevalidated ve...
30 Apr, 2025
The Centers for Medicare & Medicaid Services (CMS) recently announced a significant 5.06% increase in Medicare Advantage (MA) payment rates for 2026. This final rate, more than double the originally proposed 2.2%, represents a substantial boost for health plan sponsors working in the Medicare Advant...
10 Apr, 2025
The U.S. healthcare payer market is on the cusp of significant evolution, with Gartner forecasting an 8.5% growth in enterprise IT spending for this sector in 2025. This increase will drive total spending to $62.4 billion, an investment pattern that underscores the strategic importance of technology...
13 Mar, 2025
Health payer executives understand that navigating today’s complex healthcare landscape requires robust strategies. One framework that has proven critical to long-term success is Population Health Management (PHM). At its core, PHM seeks to improve health outcomes while managing costs and enhancing ...
5 Mar, 2025
Recent Posts
- How AI is Advancing Behavioral Health in 2025: Integration, Efficiency, and Whole-Person Care
- Transforming Prior Authorization: How CMS Proposes to Simplify and Automate the Process for Health Plans
- Health Payers: Unlock Competitive Advantage with a NCQA Prevalidated Population Health Management Vendor
- 2026 CMS Rate Increase Brings Medicare Advantage Opportunities
- The Evolving Landscape of U.S. Healthcare Payers and IT Spending Growth in 2025
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