Insurance, Payors & Plan Design
Expert articles and analysis related to insurance, payors & plan design.
AI Summary — Last 30 Days
Over the past 30 days, value-based care stakeholders have faced accelerating structural change in plan design and payer operations, driven by surging enrollment in Medicare Advantage Special Needs Plans (SNPs)—now topping 8.2 million members—and continued federal regulatory action on prior authorization, interoperability, and beneficiary protections. CMS has finalized key 2027 Medicare Advantage and Part D rules that heighten plan sponsor obligations around transparency, coverage standards, and real-time clinical review, while concurrently proposing tighter electronic prior authorization standards and turnaround times for prescription drugs—moves expected to impact provider-payer contract dynamics and care management workflows for ACOs and risk-bearing organizations (MA SNP growth & implications, Medicare Advantage and Part D CY27 rule). Since these CMS policy announcements occurred after January 20, 2025, they are actions of the Trump administration.
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Administrative burden is driving severe physician burnout
You trained for years to become a physician so you could heal people. Yet every day, you find yourself fighting the very system that is supposed to support you. A patient presents with classic symptom...
CMS proposes easing prior authorizations for prescription drugs
CMS proposes easing prior authorizations for prescription drugs Modern Healthcare
CMS releases proposed rule establishing electronic standards for drug prior authorizations
CMS releases proposed rule establishing electronic standards for drug prior authorizations American Hospital Association
Prior authorization by the numbers: 10 stats that show the strain
A 2024 CMS rule now requires payers, including Medicare Advantage plans, Medicaid, CHIP and ACA exchange carriers, to publicly report prior authorization metrics for the first time. The public report...
Insurers have Cut Prior Auth by 11% Following Commitments
Insurers have Cut Prior Auth by 11% Following Commitments MedCity News
Insurers Cut 11% of Prior Authorizations, Expand Continuity-of-Care Protections
Insurers have cut prior auth requirements by 11%: AHIP-BCBS
Insurers have cut prior auth requirements by 11%: AHIP-BCBS Becker's Hospital Review
Group cutting prior authorizations by 11% includes Aetna, Cigna
Group cutting prior authorizations by 11% includes Aetna, Cigna Modern Healthcare
Insurers have eliminated 11% of prior auths under reform pledge
Insurers have eliminated 11% of prior auths under reform pledge Fierce Healthcare
Insurers committed to cutting prior authorizations have eliminated 11% so far
Last summer, major payers committed to pare back onerous prior authorization policies, to the skepticism of providers. Now, AHIP and the Blue Cross Blue Shield Association are providing an update on i...