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News
JD Power Finds Medicare Advantage Satisfaction Drops as Members Demand Patient Advocacy
15+ hour, 48+ min ago (278+ words) hitconsultant.net What You Should Know - Overall customer satisfaction with Medicare Advantage plans dropped 12 points in 2026 to 611 (on a 1,000-point scale), marking a 41-point cumulative decline since 2024 across all measured dimensions of the member experience, according to the JD Power…...
Papa Expands Multi-Year Medicare Advantage Partnership with eternalHealth Across Massachusetts and Arizona
1+ day, 8+ hour ago (233+ words) HIT Consultant What You Should Know - Papa announced the expansion of its multi-year partnership with eternalHealth, a women-owned Medicare Advantage plan operating in Massachusetts and Arizona. - The expanded agreement integrates Papa Plus pathways into eternalHealth’s companion care benefit, specifically targeting…...
Accompany Health Report: Transforming Dual-Eligible Outcomes, Star Ratings, and MLR at Scale
2+ day, 5+ hour ago (396+ words) HIT Consultant What You Should Know - Accompany Health achieves a 55% engagement rate among attributed dual-eligible and complex Medicare Advantage members, with 99% of engaged patients in 2024 remaining actively engaged throughout 2025. - While national Medicare benchmarks average ~13 total annual touches (visits and non-visit…...
Inovalon Research Identifies Preventable Drivers of Claim Denials and Prior Authorization Delays
6+ day, 6+ hour ago (263+ words) HIT Consultant What You Should Know - An Inovalon national survey of over 400 revenue cycle management (RCM) leaders by Inovalon reveals that healthcare’s most costly billing problems begin before a claim is ever submitted. - Front-end workflow breakdowns drive 78% of denied claims,…...
Cityblock Health Expands Humana Partnership to Serve 20,000 North Carolina Medicare Advantage Members
6+ day, 8+ hour ago (312+ words) hitconsultant.net What You Should Know - Cityblock Health announced a major expansion in North Carolina to deliver its 24/7 wrap-around care model to nearly 20,000 Humana Medicare Advantage and dual-eligible beneficiaries across 50 counties. - Effective July 1, 2026, the partnership supports complex, hard-to-reach populations, including…...
CMS Releases FY 2027 IPPS and LTCH PPS Final Rule: Rates, Mandatory CJR-X Model, and EHR Changes
2+ week, 5+ day ago (157+ words) CMS Finalizes Mandatory Nationwide CJR-X and FY 2027 Inpatient Payment Rules The hospital administration, revenue cycle management, and health policy sectors face a major regulatory pivot following the release of CMS’s FY 2027 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital…...
The Hidden Risk in CMS Compliance: Why Health Plans Can’t Treat Prior Authorization APIs and Claims Attachments as Separate Projects
1+ mon, 3+ day ago (82+ words) The Convergence of Two Rules within a Health Plan Market Pressure Will Not Wait Until 2028 The Practical Health Plan Playbook The path forward for health plans is not to consolidate every regulatory initiative into a single technical build. The prior…...
How the REAL Health Providers Act Will Eradicate "Ghost Networks"
2+ mon, 3+ week ago (500+ words) The proposed Requiring Enhanced and Accurate Lists (REAL) Health Providers Act—also referred to as the RHP Act—recently signed and expected to take effect for plan year 2028, represents a significant shift in how healthcare providers are regulated, credentialed, and…...
Surescripts Expands Prior Authorization Automation: Slashing Prescription Approval Times as New CMS Interoperability Rules Loom
2+ mon, 4+ week ago (160+ words) The core value of Surescripts’ updated infrastructure lies in its ability to transition prior authorization from a reactive, retrospective scramble into a seamless, electronic “system of action” executed at the point of care. When the clinical documentation matches the pre-established…...
Why Medicare Advantage App Usage is Plummeting While Commercial Adoption Soars
4+ mon, 1+ week ago (171+ words) J.D. Power 2026 U.S. Healthcare Digital Experience Study Ranks Cigna and UPMC Highest Over the last five years, national health insurers have poured billions of dollars into building the ultimate “digital front door.” They launched sleek mobile apps designed to help members check…...