Operations
The insurer was set to limit reimbursement, starting Jan. 1, 2026, for remote physiologic services to heart failure and hypertensive disorders of pregnancy.
Making AI-driven changes adds $4 million to $6 million per 10,000 discharges each year, equaling tens of millions of dollars in additional reimbursement, says Todd Van Meter, CEO of Accuity.
The money must be spent on sustainable initiatives such as reducing avoidable readmissions or length of stays, expenses that need data and analytics to start bending the cost curve, says Anna Basevich, SVP at Arcadia.
Proposed rule increases requirements for price comparison tools by aligning them with consumer protections established under the No Surprises Act.
Reviewers looked at how the company manages patient care and, reportedly, prior authorization requests by healthcare providers.
In the best case scenario, hospitals “are getting 20% less than the lowest workman’s comp fee schedule in the country,” says Zachary Schultz of EnableComp.
A relatively new form of H3N2 identified this year called Clade K has resulted in increased cases, says Andy Pekosz of the Johns Hopkins Bloomberg School of Public Health.
Atropos Health CEO Brigham Hyde says the company's AI Evidence Agent integrates directly into Microsoft Teams to provide tumor boards with concise, citation-backed guidance tailored to patient data in real time.
All community and independent pharmacies in the Optum Rx network are transitioning to cost-based contracts.
On Jan. 1, impacted payers will have limited time to respond to prior authorization requests, as mandated in the Interoperability and Prior Authorization final rule.