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The transition from fee-for-service models to value-based care (VBC) represents a major shift in the healthcare industry, requiring payers and providers to prioritize quality outcomes and cost efficiency. According to recent research from Gartner, "AI in Value-Based Care: Part 1 Roadmap Planning for...
9 Jul, 2025
Prior authorization (PA) processes have traditionally been a pain point in healthcare, often leading to delays in care, administrative burdens, and frustration for both patients and providers. Recognizing the need for improvement, health plans across the country have committed to streamlining and si...
23 Jun, 2025
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
Recent Posts
- AI in Value-Based Care: Unlocking New Possibilities for Healthcare Payers
- Simplifying Prior Authorization with Technology and Innovation
- 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
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