The Quiet Battle for the Front Door of Healthcare
This is not a debate about care models or physician preferences. It is a contest over who will control the referral pathways and the revenue streams that originate at the front door of healthcare.
The Path to Fair PBM Competition
When control over prescription drug access rests with only a few players, the result is not just market imbalance — it is higher plan costs, increased financial pressures, and ultimately reduced affordability for patients.
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Inside an Automated Healthcare Practice: Redesigning Care Around People, Not Paperwork
By reducing administrative burden and redesigning workflows around human needs, it creates space for what matters most: connection between clinicians and patients.
Healthcare’s Data Orchestra: Why Rising Drug Denials Signal a Need for Better Coordination
The real story isn’t about denial rates or stakeholders acting as villains. It’s about a healthcare system that forces intelligent, well-intentioned professionals to make critical decisions in information silos.
White Bagging: A Prescription for Disruption in Care
White bagging not only creates significant uncompensated administrative burden and scheduling challenges for providers, but it also delays or limits access to necessary medication for patients.
Prior Authorization Reform Is Finally on the Table — Standards Must Be Too
It’s a meaningful step. But declarations alone won’t fix a system still powered by fax machines, phone calls, and inconsistent rules. Real progress will require a modern digital infrastructure, aligned incentives, and coordinated action across both the public and private sectors.
A Four-Part Roadmap for Responsible Prior Authorization
The tools exist today to significantly reduce PA's burden on our healthcare system, we just need to mobilize and implement them.
Beyond Analytics: How Sellers Dorsey is Hard-Coding Value into Medicaid Policy [Video]
How to turn analytics into actual policy outcomes.
How Health Insurers Are Embracing Technology to Serve Real People
The time to innovate is now. By embracing transformative solutions, insurers and employers can not only address systemic challenges but also create a future where healthcare is equitable and sustainable.
Zero-Sum Game: The Current Healthcare System Is Reaching a Breaking Point
It’s tragic that it takes a shooter, aggravated by his back pain and frustrated with the healthcare system, to spark a necessary conversation about healthcare.
Will A Second Trump Term be a Financing Boon for Healthcare?
The impact of private equity investments in healthcare under the new administration is multifaceted. While deregulation and business-friendly policies could stimulate investment and drive innovation, there are significant concerns about the potential negative effects on healthcare quality and access.
FDA Commissioner: Insurers Need To Support Studies In Accelerated Drug Approval Pathway
Physicians face a lot of barriers from insurers in completing studies on drugs in the accelerated approval pathway, declared Dr. Robert Califf, commissioner of food and drugs at the Food and Drug Administration. Insurers need to help, he said during the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum.
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Survey on the Healthcare Financial Landscape Offers a Roadmap for Stakeholders
Zelis highlights how employers, payers, and consumers are integrating digital tools to manage healthcare costs.
Leapfrog: Employers Give Health Plans a ‘C’ Letter Grade
A survey from The Leapfrog Group asked employers to give their health plans an "A" through "F" letter grade. From those letter grades, Leapfrog calculated the health plans’ average Grade Point Average (GPA) on a 4.0 scale. Health plans received a 2.29 GPA in 2022, a slight decrease from Leapfrog’s prior survey in 2020, which had a 2.57 GPA.
Americans Are Confused With Their Medical Bills. Here’s How the Healthcare Industry Can Help
Nearly 40% of Americans struggle understanding their medical bills, a recent survey showed. But receiving more communication and support from providers and insurers would make bills less confusing, the respondents shared.
Report: Health Plans Need To Do Better When It Comes to Care Navigation
About 62% of Americans don’t trust their health plan when it comes to finding care, a Ribbon Health survey found. Providing more accurate information on provider directories could repair this trust.
Consumers Need Better Communication From Their Health Plans, Survey Shows
More than half, or 58%, of health plan members are “overwhelmed” when it comes to managing their health plans. Insurers need to provide information in a way that's accessible and easy to understand, the report stated.
Report: Insurers from 55 countries expect healthcare benefit costs to jump 10% in 2023
The 10% increase is the largest in almost 15 years, the Willis Towers Watson survey found. Most of the insurers, or 75%, blamed the overuse of care for the rise in medical costs.