Individual Coverage Is Reshaping Health Insurance. Agents Are the Key to Making It Work
As individual enrollment grows, agents must evolve to meet a more complex, consumer-driven market.
Housing is the Next Frontier in Proactive Care. Here’s How Health Plans Can Help
Just as health plans have learned to identify and intervene early with chronic conditions like diabetes or heart disease, they can and should do the same for housing and other health-related social needs.
The Mechanics of a More Connected Healthcare Ecosystem [Video]
Arbiter’s Anjali Jameson on hospital and payer alignment.
The Referral Is Broken: Why Healthcare’s Last Bottleneck Still Lacks Innovation
We've automated everything but the one workflow that most directly determines whether patients actually get the care they need. The gap between knowing what works and implementing it at scale reveals the real problem that healthcare treats referrals as an administrative burden to manage, not a critical workflow to optimize.
Changes Are Coming to 2026 Medicare Benefits
Here are three things providers should consider when it comes to Medicare.
The OBBBA Is Creating Uncertainty and Disruption: What Health Plans Need to Know
Health plans are being asked to adapt quickly, to reconfigure technology, reimagine operations, and anticipate ripple effects that stretch across claims, member engagement, compliance, and workforce strategy.
President Trump Can Act Now To Make Healthcare Affordable
The Trump administration can immediately take these two price transparency administrative actions to reduce costs and improve affordability.
How Artera is Using Agentic AI to Humanize Patient Care
Artera President Tom McIntyre talks about the practical application of AI in healthcare.
Teletherapy Alone Will Not Solve The Mental Health Access Issue
New mental health treatment tools based on technology work, and outcomes are exceptional. Now health plans must expand coverage so more patients can access these new treatments.
Building a Foundation for HEDIS Success Amid Change
Strategic planning for the upcoming measurement year should incorporate thorough communication between the health plan, its HEDIS vendor, and auditor.
Why Health Plans Are Reclaiming Utilization Management, and What It Takes to Do It Right
CMS and AHIP are raising the floor, but forward-thinking plans are aiming higher. They’re designing utilization management systems that are clinically sound, operationally efficient, and aligned with enterprise goals.
The Path to Fair PBM Competition
When control over prescription drug access rests with only a few players, the result is not just market imbalance — it is higher plan costs, increased financial pressures, and ultimately reduced affordability for patients.
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Survey on the Healthcare Financial Landscape Offers a Roadmap for Stakeholders
Zelis highlights how employers, payers, and consumers are integrating digital tools to manage healthcare costs.
Turning Missed Appointments into Meaningful Member Action
Improving no-show rates is not just about perfecting our reminders — it’s about redesigning the member experience from the ground up and creating systems that reflect and accommodate the realities of members’ lives.
Why Insurers Need to Lead in the Shift to Healthcare Consumerism
We’re in the middle of a fundamental shift that’s giving consumers more power and choice over their health coverage while creating healthy competition in the marketplace. Consumer expectations are justifiably rising, and people want a much more pleasant, frictionless and digital experience from their health plan – just like they get everyplace else in their lives.
The Delegation Dilemma: Why It’s Time for Health Plans to Rethink Vendor-Managed Utilization Management
As an industry, we need to ask hard questions. Are delegated vendors delivering on the promise of better, faster, more transparent decisions? Or are they simply moving the pain to another part of the system?
Healthcare Price Transparency is Not Enough
Health care in the United States is confusing for patients and consumers. Price transparency is a step in the right direction — transformative change can happen by combining cost, quality, appropriateness and efficiency measures.
Why Behavioral Science Is A Significant Untapped Resource For Many Health Plans, And How They Can Better Leverage It
A small number of innovative health systems and plans have incorporated technology and cultural integrations that recognize the comprehensive cognitive, social, and environmental drivers and barriers that influence member behaviors. However, progress has been slow — here are three key areas where behavioral science can significantly impact plans and their members.