PBMs may represent everything wrong with U.S. healthcare
Pharmacy benefit managers (PBMs), which claim a significant portion of healthcare spending, exemplify the broader exploitation by intermediaries in U.S. healthcare, prompting urgent calls for Congressional scrutiny and systemic reform.
UnitedHealth Group – The “Death Star” of U.S. healthcare
UnitedHealth Group’s aggressive acquisition strategy, particularly in areas where it dominates Medicare Advantage, highlights its influence over the U.S. healthcare system and underscores the need for providers to understand and strategically navigate its impact.
So much Medicare Advantage noise, so little time
Medicare Advantage (MA) plans have emerged as a trillion-dollar market for health plans. But does Medicare Advantage work for taxpayers who fund it?
Three things you need to know about Medicare Advantage today
Medicare Advantage’s rapid growth is straining hospitals and health systems due to low reimbursement rates, rising denials, and payment disputes, requiring providers to adopt data-driven strategies and proactive contract negotiations to maintain financial stability.
2023 revenue challenges: Turning the tide in 2024
In 2023, hospitals and health systems faced financial pressures from Medicaid redeterminations, Medicare Advantage’s rapid growth, and shifting expectations of commercially insured patients, requiring proactive strategies in reimbursement, contract negotiations, and patient retention to navigate these challenges effectively.
Denials by bots: Why providers need to keep an (even closer) eye on claims
Payers increasingly rely on AI and automation to process claims, leading to higher denial rates, lawsuits, and scrutiny, necessitating proactive provider strategies to challenge harmful practices and safeguard revenue.
Shifts in healthcare, provider hurdles, & the flywheel effect
Health insurance vertical integration models, like the one leveraged by UnitedHealth Group, highlight the need for strategies to address evolving payor tactics.