Aledade, Humana Expand Value-Based Partnership to Support FQHCs and Rural Health Clinics
An expanded partnership with Humana will help Aledade’s FQHC and rural health clinic partners share savings in Medicare Advantage.
FarmboxRx Introduces Platform for Addressing SDOH Needs
FarmboxRx's new platform provides tailored support to help members engage with their health benefits.
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How PDPM Optimization Improves Facility Financial Performance
Transitioning to PDPM models significantly shifted the healthcare industry. By replacing the RUG system, healthcare providers cut waste and more accurately reflect the care each patient received.
Hinge Health is Going Public. Is It Wise?
Amid the market volatility and intense macroeconomic uncertainty, is it wise for Hinge Health to test the public markets?
Why This Health Plan Moved Away from Exclusive Relationships with Specialty Pharmacies
Several years ago, Highmark began questioning its exclusive relationships with specialty pharmacies and started working with Free Market Health, which matches patients to the pharmacy that best fits their needs.
More than 65 Organizations Call on Workplaces to Provide Comprehensive Obesity Care Coverage
The Alliance for Women’s Health and Prevention and several other organizations are urging employers to cover the "full range of evidence-based obesity care options," including medical nutrition therapy, intensive behavioral therapy, surgery and medications.
A 2,100% Markup: My Battle with a Vastly Overpriced Knee Brace — and U.S. Healthcare
I asked if I could purchase the brace myself and bring it to the surgery. The answer was an unequivocal no: the health insurer’s contracted rate required me to purchase the brace from the hospital as part of the procedure.
A Data-Driven Guide to Patient Access Success
A new report from Relatient, A Data-Driven Guide to Patient Access Succes, highlights how focusing on data accuracy and relevance can enhance the performance of healthcare practices.
4 Prescription Drug Trends that are Top of Mind for One Abarca Exec
Abarca Health is paying attention to specialty drugs, AI in healthcare, the impact of obesity-related conditions, and increased government regulations.
Inside Healthcare’s Hottest New AI Category: Agentic AI
Healthcare organizations are starting to implement AI agents — autonomous, task-specific systems designed to perform functions with little or no human intervention. While initial adoption is focused mainly on non-clinical areas like scheduling and prior authorizations, experts predict that AI agents could eventually play a role in clinical decision-making, provided they meet rigorous safety and reliability standards.
Better AI + Correct Provider Guidance = Fewer Denials
How do we tip the scale to lower the rate of denials? While AI has been the initial decision-maker for years, it must become better trained. And to do that, it needs help.
How High is Too High? The Crippling Cost of Denial Rates
Patients should know exactly what's covered and what it costs before receiving care. Doctors should be empowered to make medical decisions without interference from insurance companies. And the entire process should be designed to facilitate care, not obstruct it.
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Top-Rated Practice Management Solutions for Med Spas
Every wellness clinic is only as successful as the capabilities of its software. Here's where you can find the top-rated practice management solutions for med spas.
Sonder Health Plans Taps Cleo for Care Coordination & Family Caregiving Support
Cleo will now be providing family caregiving support to Sonder Health Plans' Medicare Advantage members. This includes connecting them with medical and social support.
The Promise and Peril of Price Transparency Under Trump’s New Executive Order
President Donald Trump’s latest executive order aims to strengthen enforcement for CMS’ price transparency requirements. Some experts think greater price transparency could reduce healthcare costs by fostering more competition, while others are concerned about the potential effects on hospital-payer negotiations, as well as the practicality of enforcing these requirements.
Healthcare Moves: A Monthly Summary of Hires, Exits and Layoffs
February has seen a slew of executive hires, exits and layoffs across the healthcare industry. For example, health tech companies like Cadence and Bamboo Health hired new C-suite leaders, and providers like Mass General Brigham and Corewell Health announced rounds of job cuts.
MedCity Pivot Podcast: Being Clear About Cybersecurity
A conversation with David Bardan, the general manager of the healthcare business at Clear, shows how the company is bringing its expertise to counter cybersecurity threats in the healthcare industry.
UnitedHealth Hit with 2 New Federal Probes in 1 Week
This week, UnitedHealth Group faced two new investigations from federal lawmakers. The first was a senator’s probe into its Medicare Advantage billing practices, and the second was a Congressman's investigation into a decline in care quality at Optum-owned clinics in New York.