Payer & Insurance Strategies
Expert articles and analysis related to payer & insurance strategies.
AI Summary â Last 30 Days
Synthesis:
In the past 30 days, CMS has intensified its push toward technology-enabled value-based care by launching the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model, accepting over 150 organizationsâincluding numerous digital health firmsâto manage outcomes for high-burden conditions like obesity and diabetes under voluntary, lean payment arrangements. Simultaneously, the agency halted the BALANCE model due to insufficient payer engagement, underscoring persistent tensions between voluntary participation and payer alignment. These developments signal a strategic pivot: CMS is betting on digital innovation and outcomes-based incentives to drive ACO participation and population health impact, while still working to resolve fundamental engagement challenges in value-based payment initiatives (CMS halts BALANCE model).
Related Articles
The Operational Drag of Prior Authorizations and the Moral Hazard Impact on Patients
Prior Authorization Is Source of Greatest Patient Burdens in the Health System, Poll Finds
Payers need to speed up prior authorization for drugs under proposed rule
Health insurers face a prior authorization prescription drug mandate similar to the rule imposed on claims, under a proposal released Friday by the Centers for Medicare & Medicaid Services.CMS is prop...
CMS proposes new deadlines for prior authorizations for drugs
Drugs were left out of a 2024 rule streamlining prior authorizations by making decisions electronic and requiring payers to turn them around more quickly. The Trump administration is looking to addres...
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