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 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 Lynn Carroll – The dramatic loss of revenue by healthcare providers during the COVID-19 pandemic was a sobering reminder that healthcare organizations rely on the traditional FFS revenue model at their own peril. In response, more provider groups are implementing APMs built around financial incentives.
By Michael Drescher – Health care has benefitted tremendously in the past decade from the explosion of data of all kinds. From more accurately identifying and tracking trends in care delivery, to developing the ability to predict the likely onset of disease, to documenting the real-world effects of…
By Matthew Albright – The issue of surprise billing has long plagued the U.S. healthcare system. The need for legislation to protect individuals from surprise billing is strikingly clear, as studies reveal that one in five emergency room visits result in an unexpected bill for patients.
By Suzanne Cogan – The relationship between payers and providers has come a long way over the last decade, as the push toward value-based care has shifted the dynamic between the two healthcare stakeholders.