By David Van Houtte – With a recent increase in rules and regulations from CMS, health plans are feeling the pressure of more scrutiny, and the fear of penalties looms. For example, the No Surprises Act, passed in 2022, has already resulted in healthcare facilities, payors, and providers paying more than $11 million in penalties.
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By Kathryn Eshelman MD MPH – Unlike Medicare Advantage, risk adjustment in Medicaid is a zero-sum game. Medicaid is managed at the state level with fixed budgets, and the slice of the pie your health plan receives depends on the effectiveness of its risk adjustment program.
By Greta Barnes – Imagine Jane, a mid‑level project manager, powering through another flare‑up of her rheumatoid arthritis. Her joints ache, fatigue drapes over her like a heavy blanket, and she knows she needs to take a day or two away from her desk. When she checks her company’s PTO policy, however, she’s met with rigid accrual tiers and a “use it or lose it” deadline.
By Ellie Gabel – Internet of Things (IoT) solutions have seen rapid growth across the health care industry. Patient-monitoring wearables may be the most prominent example of this technological shift, but connected technologies also have vast potential in the operating room.
By Chelsea Richwine – In 2024, more patients than ever before accessed their medical records online through web browsers and apps to manage their health – here’s why that matters.
By Mark Coetzer – The pace of healthcare modernization is accelerating. With value-based care becoming the norm, organizations across the care continuum are under pressure to improve outcomes, reduce administrative burden, and meet increasingly complex reporting requirements.
By Phil Galewitz & Stephanie Armour – Doctors, hospitals, and health insurers for weeks issued dire warnings to Republican lawmakers that millions of people would lose health coverage and hospitals would close if they cut Medicaid funding to help pay for President Donald Trump’s big tax and spending bill.
The thought leaders in our community are good about sharing their thoughts on the issues of today. Here are the top read and shared guest posts of June that we think deserve sharing again.
By Steven Posnack – As we roll into the second half of 2025, we wanted to state our TEFCA™ priorities and plans for the remainder of the year.