By Joan Butters – A KFF survey from 2023 revealed nearly one in five adults had health insurance claims denied in the previous year. On a national level, that suggests millions of disaffected patients. The growing public frustration with the cracks in our healthcare industry has exploded into a national conversation.
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By Ram Krishnan – Navigating payer stipulations in behavioral healthcare can be a challenge, as they are often more complicated than those for physical healthcare. However, understanding how to maintain compliance and bill properly is something that behavioral health clinicians and practice owners have to do to maintain business efficiency, avoid revenue losses, and provide timely care to patients.
By Stephanie Fraser – At HIMSS25, a distinguished panel of health plan leaders gathered to discuss how payers are moving beyond fee-for-service models and embracing AI, digital health and value-based care to advance patient outcomes and drive system-wide transformation.
By Amit Shah – HEDIS is a measurement set used to determine the efficacy of a payer to care for its members. The performance data collected through HEDIS assists payers in identifying areas for improvement as well as tracking successes through a measurement set that allows them to be compared to other payers.
By Misty Graham – Key stakeholders in the healthcare industry, including health plans, clinical data registries, and accountable care organizations, must collaborate to improve health outcomes, enhance patient experiences, manage chronic diseases, and provide better access to care while keeping costs low.
By Lynn Carroll & David Wolf – The fundamental goal of value-based care (VBC) is to improve patient health outcomes by prioritizing preventive care and wellness, thereby reducing overall healthcare spending through better management of costly chronic diseases.
By Christie Scanlon – Within healthcare’s intricate landscape, a complex interplay exists among three principal entities: patients, providers, and payers. This dynamic can be likened to the “Three-Body Problem” in physics—a concept from Liu Cixin’s science fiction novel…
By David L. Morris – The healthcare industry is witnessing a monumental shift toward alternative payment models. Among them, capitation is growing in popularity as one of the most durable ways to stabilize costs and focus on preventive and primary care.
By Jocelyn Keegan – Healthcare technology policy, especially rules impacting payers, are coming at us at a fast and furious pace coupled with new enforcement teeth. Executives and leaders in payer organizations face a pivotal decision — Do they simply fulfill regulatory compliance requirements, or do they…