8+ mon, 3+ week ago   (477+ words) Here are three things providers should consider when it comes to Medicare. Medicare open enrollment is in full swing and big changes are on the way in 2026 for providers – from physician fee schedules to a pilot test of prior authorization…...

10+ mon, 3+ week ago   (565+ words) CMS Administrator Dr. Mehmet Oz said that Medicaid’s rapid spending growth is unsustainable and criticized state financing tactics that let providers and governments “game” the system for extra federal funds. He said CMS is shifting its fraud strategy to follow…...

9+ mon, 6+ day ago   (431+ words) CMS is proposing major changes to Medicare Advantage Star Ratings, drawing mixed reactions from healthcare leaders. In recent years, there have been numerous lawsuits from Medicare Advantage plans against the Centers for Medicare and Medicaid Services over Star Ratings, including…...

5+ mon, 5+ day ago   (657+ words) Healthcare leaders can’t tell whether value-based care and Medicare Advantage are truly lowering costs. Some see promise in these models and ongoing innovations, while others say the programs haven’t delivered measurable savings and point to direct contracting as a more…...

9+ mon, 4+ day ago   (783+ words) Healthcare costs in America are rising at unsustainable levels. The past two years brought the highest back-to-back cost hikes in a decade — and the trend shows no signs of slowing down as employers brace for another 9% increase in healthcare costs…...

10+ mon, 1+ week ago   (200+ words) The 2025 Benefits Sentiment Index is based on a survey of 120 benefit consultants to self-insured employers and is sponsored by Quantum Health. The third annual edition of the 2025 Benefits Sentiment Index, a survey of 120 benefit consultants to self-insured employers, finds that…...

10+ mon, 2+ week ago   (71+ words) Clever Care CEO discussed the importance of culturally-competent care. Clever Care Health Plan CEO Karen Walker Johnson talked about how her career has informed her approach to Medicare beneficiaries, culturally competent care, and how her company’s approach to benefits design…...

8+ mon, 3+ week ago   (1481+ words) CMS’ new ACCESS model, slated to begin on July 1, aims to shift traditional Medicare fee-for-service toward value-based care by tying payments to patient outcomes and encouraging tech-enabled, preventive care. Experts say it could benefit digitally mature, value-focused providers first, but…...

9+ mon, 3+ week ago   (667+ words) For years, utilization management (UM) was quietly delegated away for scale, speed, and supposed efficiency. But today, health plans are hitting the breaking point. What’s emerging isn’t just a call for reform; it’s a clear shift in strategy: reclaim control,…...

5+ mon, 1+ week ago   (216+ words) In the latest episode of the Debunked podcast, MedCity News Editor-in-Chief Arundhati Parmar and Samir Batra, Managing Partner of Health Innovation Pitch, discussed recent M&A deals and how bots can be manipulated. Several March M&A deals caught the…...