Managed Care & Payer Strategy
Expert articles and analysis related to managed care & payer strategy.
AI Summary â Last 30 Days
Over the past 30 days, CMS has advanced a structural shift in Medicare payment by launching the ACCESS model, enrolling over 150 technology-enabled participantsâincluding Verily and Noomâto scale outcome-based reimbursement for chronic disease management in areas such as obesity, diabetes, musculoskeletal pain, and depression. This voluntary program signals a move toward "lean" payments tied to measurable results, incentivizing digital health partnerships and accelerating adoption of value-based care strategies among providers and payers while testing the viability of new risk-sharing models in real-world settings (Healthcare IT News, Healthcare Finance). As traditional ACOs and managed care organizations evaluate participation and integration paths, the ACCESS modelâs outcome alignment and digital-first approach are reshaping expectations for Medicare chronic careâand may set broader precedents for future CMMI payment models.
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How CVS Caremark is using innovative technology to simplify the prior authorization process
How CVS Caremark is using innovative technology to simplify the prior authorization process  Fierce Healthcare
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-BCBSÂ Â Becker's Hospital Review