Healthcare Payers

Curious about 2025 #healthcaretrends on GLP-1s, AI in healthcare, telehealth and virtual healthcare, healthcare coverage and more? We've got you covered with our latest episode of Healthcare Strategies. Our own Veronica Salib, Anuja Vaidya, Shania Kennedy, and Kelsey Waddill cover some of the biggest items that we'll be watching this year. Follow us on Spotify and Apple and drop us a review and star rating to let us know what you think! You can also find clips from the podcast on our YouTube channel, @HealthcareStrategies.

The Medicaid Primary Care Improvement Act, a law that has passed in the House and is now under consideration in the Senate, seeks to expand the opportunities for direct primary care arrangements in Medicaid.

With so many problems to solve, how can payers focus their efforts to achieve strong #populationhealth strategies? Don Antonucci from Providence Health Plan shared his thoughts at our Payer+Provider virtual summit. How has your organization tackled these five pillars of pop health? Comment below, we'd love to hear!

The five Medicare Advantage payers with the largest footprint in 2025 made their case to beneficiaries by positioning themselves on #affordability, #quality and #accesstocare. Check out our coverage of the top five Medicare Advantage plans in 2025 by county and what they are offering to beneficiaries in the new year.

ICYMI: ACA open enrollment for 2025: What you need to know https://lnkd.in/emxnqRpZ CMS is continuing many of the strategies that have worked in the past and returning to some previously successful approaches. Meanwhile, its focus continues to be reducing costs, increasing access to plans, and maintaining strong outreach. Things to watch: - Premium tax credits will be extended to DACA recipients - Marketplace plans proliferate - Continued investment in outreach

Payers know that equipping providers to manage members' social determinants of health challenges leads to better individual and population health outcomes. But with workforce shortages and higher administrative demands diminishing providers' bandwidth, #dataanalytics around #socialdeterminantsofhealth initiatives are more important now than ever. Thank you to Sarah Ahmad from CAQH, Roy Beveridge MD from Avalere, and our own Sara Heath for diving into this topic. Check out this clip for more: https://lnkd.in/etBcNcxG CAQH will be participating in our Payer+Provider virtual summit this November. To hear more about the intersection of data and population health, join us for the summit on November 12 - 13, 2024. To register, visit: https://lnkd.in/e3aqNkvz If you want to hear the rest of Sarah, Roy, and Sara's conversation, head on over to our Healthcare Strategies podcast. Don't forget to leave us a review to possibly be mentioned in one of our episodes. https://lnkd.in/eWdQtH4t

#Analytics platforms, omnichannel engagement tools, #telehealth, and other technological and data advancements have been pivotal to successful payer #patienteducation. Thanks, Cathy (Mary) Moffitt, MD, FAAP, CHIE, for sharing best practices and giving some insight into the Aetna, a CVS Health Company approach to patient education in health insurance. Find out more on https://lnkd.in/d4ekdHz.

"Health plans are being challenged with getting out of their comfort zone a little bit and making a concerted effort to address the needs of this population within the larger program that has unique needs, unique challenges that require specialized attention on the part of the health plan." - Juan Montanez, FTI Consulting

The No Surprises Act's independent dispute resolution process provides a channel for payers and providers to negotiate payments without affecting patient spending. But who is involved and how does it work? HealthPayerIntelligence has you covered.

Some states have already cut in-person interviews and limited renewals to once a year, aligning with Medicaid and CHIP final rule policies. - https://bit.ly/4asGsfN