New & Notable
HHS seeks to secure PrEP, birth control coverage
A proposed rule supports birth control coverage for FDA-approved therapies and devices with no prescriptions or cost-sharing and clarifies the exceptions process for enrollees.
Medicare Advantage growth persists ahead of open enrollment
Medicare Advantage growth continues, spurred on by high quality of care, lower costs and better access to care.
CMS, HHS update Medicare drug price negotiation process
The next Medicare drug price negotiation cycle might see new parameters around the negotiation platform and more talks around patient experience and pharmacy concerns.
Top health insurance trends based on quality measures
The 2024 NCQA Health Plan Ratings revealed quality measure performance trends that could guide payers’ decisions on major topics like health equity and diabetes care going forward.
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Insights is the research division of Xtelligent Healthcare Media. Our work aims to leverage Xtelligent’s diverse readership of healthcare professionals across various sectors of the industry to understand real-world challenges and identify effective solutions.
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Latest News
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Employer strategies to address factors driving healthcare costs
High healthcare costs have motivated employers to think creatively about their benefits and strategies, from rethinking their partnerships with PBMs to finding ways to limit GLP-1 utilization.
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How enhanced premium tax credits could affect health equity
If the Inflation Reduction Act's enhanced premium tax cuts are renewed in 2025, they could increase enrollment among populations with higher uninsurance rates.
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Members rarely challenge coverage denials, surprise billing
Only 45% of individuals who received a surprise bill challenged it and only 43% of those who were denied coverage appealed the decision.
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CMS shares Medicaid, CHIP data on children with ASD, autism
CMS found that half of the children with these conditions in public payer programs were diagnosed early, which could positively impact outcomes.
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Medicare Advantage, individual markets did well financially in 2023
As plans continue to recover from the pandemic, Medicare Advantage plans continued their strong performance, financially, in 2023.
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5 Ways to Modernize the Healthcare Payments Experience
Modernizing the healthcare payments experience can improve efficiency, compliance and satisfaction among health plans, providers, and members.
Features
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Key MA quality bonus payment program outcomes, concerns
Understanding the quality bonus payment program is critical to appreciating Medicare Advantage and discussing the calls for reform.
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What are the differences between Medicare Parts A, B, C, D?
Medicare includes four different segments that each insure a wide variety of services and supplies for enrollees.
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Data, technology strategies boost payer patient education
Analytics platforms, omnichannel engagement tools, telehealth, and other technological and data advancements have been pivotal to successful payer patient education.
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A VBC approach to improving pediatric behavioral healthcare access
Behavioral healthcare access for children and adolescents is lacking, but payers can use value-based care systems to increase and optimize referral opportunities.