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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
The intersection of behavioral and physical health represents one of the most promising advancements in healthcare today. For decades, the fragmented nature of healthcare made it challenging to treat individuals holistically. Behavioral health conditions often went undetected or untreated, further c...
20 Feb, 2025
Recent Posts
- 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
- Leverage the Power of Analytics for a Successful Population Health Management Framework
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