Tag: Managed Care
May you live in interesting times
The current healthcare system, dominated by a few powerful health plans, highlights the urgent need for systemic redesign focused on patients rather than insurance companies, requiring long-term strategies and transformative...
Hospitals are damned if they do, damned if they don’t
Hospitals, facing mounting bad debt from insured patients and pressures from the No Surprises Act, are increasingly requiring advance payments for non-emergency care, navigating criticism while striving to balance financial...
Prior authorizations should be renamed ‘the Care Avoidance Process’
The widespread use of prior authorizations by insurers delays care, undermines physician-patient relationships, and improperly denies treatment, highlighting the urgent need for collective provider action and stronger protections against these...
Is the nation’s largest payor becoming a closed system?
UnitedHealth Group's transformation into a closed healthcare system, driven by its subsidiary Optum, raises concerns about reduced competition, patient choice, and fairness, emphasizing the need for providers to secure protective...
PBMs may represent everything wrong with U.S. healthcare
Pharmacy benefit managers (PBMs), which claim a significant portion of healthcare spending, exemplify the broader exploitation by intermediaries in U.S. healthcare, prompting urgent calls for Congressional scrutiny and systemic reform.
UnitedHealth Group – The “Death Star” of U.S. healthcare
UnitedHealth Group's aggressive acquisition strategy, particularly in areas where it dominates Medicare Advantage, highlights its influence over the U.S. healthcare system and underscores the need for providers to understand and...
So much Medicare Advantage noise, so little time
Medicare Advantage plans have grown significantly, benefiting insurers through higher taxpayer costs driven by coding intensity, while raising concerns about their effectiveness and necessitating strategic evaluation by providers and government...
Three things you need to know about Medicare Advantage today
Medicare Advantage's rapid growth is straining hospitals and health systems due to low reimbursement rates, rising denials, and payment disputes, requiring providers to adopt data-driven strategies and proactive contract negotiations...
2023 revenue challenges: Turning the tide in 2024
In 2023, hospitals and health systems faced financial pressures from Medicaid redeterminations, Medicare Advantage's rapid growth, and shifting expectations of commercially insured patients, requiring proactive strategies in reimbursement, contract negotiations,...