The Accuracy-Adequacy Paradox
A regional health plan improved its provider directory accuracy by 8%, only to discover hundreds of specialists listed as “in-network” had moved or stopped practicing. Rather than losing coverage, the plan leveraged…
What You Should Know:
– A new 50-state analysis reveals that over half (51.7%) of U.S. private-sector workers are now enrolled in high-deductible health plans (HDHPs) as employers struggle to manage rising costs. The report…
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Kevin Deutsch, General Manager and SVP of Health Plan Solutions at Softheon
The upcoming Affordable Care Act (ACA) Open Enrollment (OE) period presents at least three major challenges for health plans: Legislative changes, double-digit premium…
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What You Should Know:
– New analysis of Texas hospital price data reveals a transparency paradox: discounted cash prices for common services are often significantly lower than the rates hospitals negotiated with commercial insurers, according…
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What You Should Know:
– Evidium, an innovative healthcare artificial intelligence company, has announced the close of its Series A equity funding round co-led by Health2047, the venture studio of the American Medical Association (AMA),…
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What You Should Know:
– Press Ganey, the leader in experience measurement, analytics, and advisory services for health systems and health plans, today released its extensive report, Healthcare consumer experience 2025.
– The report explores new…
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Naomi Murphy, J.D., Senior Vice President, COB and Data Mining, Cotiviti
Coordination of benefits (COB) is a key component of any effective payment integrity program. But determining primacy for members with multiple plans and ensuring…
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What You Should Know:
– Popai Health, the Patient Conversation Intelligence company, today announced it has raised $11M in seed funding led by Team8 and NEA, alongside additional strategic investors,
– The capital intended to strengthen…
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The following is a guest article by Mark Noel, SVP and GM of ClaimInsight at AMPS
As health plans face escalating medical costs and increasing scrutiny over member and provider satisfaction, a critical strategic challenge…
The Oversubscribed Round, Led by Wellington Management and General Catalyst, Will be Used to Enhance and Scale the Company’s Enterprise Health Platform, and Transform Health Benefit Management and Administration for Employers and Plans
Rebrand Signals…
