What to expect in 2025: Managed care trends and predictions
New president. New Congress. Decades old healthcare cost finger pointing. Payors and providers say change is needed. Yet there’s no consensus on how to achieve it. In our new report, we share our views on six areas to watch in managed care this year.
We need an attitude of genuine humility to address a healthcare system in desperate need of change
The murder of UnitedHealth Group CEO Brian Thompson has ignited a heated debate about systemic issues in the U.S. healthcare system, highlighting the urgent need for reform while condemning violence and dehumanization.
The risks of opting out of the landmark BCBS antitrust settlement
The Blue Cross Blue Shield antitrust settlement offers healthcare providers $2.8 billion in compensation and systemic BlueCard improvements, with opting out posing significant risks of costly, prolonged litigation and forfeiture of transformative benefits.
Beyond the payout: How the BCBS antitrust settlement will transform the BlueCard program for providers
The recent $2.8 billion Blue Cross Blue Shield antitrust settlement, coupled with mandated system improvements, promises to address long-standing issues with the BlueCard system, ensuring more timely payments, increased transparency, and reduced administrative burdens for healthcare providers.
More Medicare Advantage turmoil
Medicare Advantage plans face growing scrutiny and rejection by providers due to payment challenges and administrative complexities, prompting hospitals to reassess contracts and seek strategic support for managed care negotiations and partnerships.
New era of conflict with independent Blues?
Independent Blue Cross Blue Shield plans are increasingly in conflict with providers due to aggressive cost-cutting measures, high denial rates, and contentious contract negotiations, emphasizing the need for strategic managed care planning to navigate these challenges.
Debunking the RAND Study: How flawed data is hurting U.S. hospitals
The RAND hospital pricing study, widely cited by employers, insurers, and policymakers, is criticized as methodologically flawed, with misleading conclusions that unfairly portray hospitals as overcharging, risking further financial destabilization for healthcare providers.
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 change to address decades of dysfunction.
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 stability with patient protection and clear communication.