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On a new episode of the Gist Healthcare podcast, Joyjit Saha Choudhury joins host J. Carlisle Larsen to talk about his recent piece, Preparing for Medicare Advantage’s Make-or-Break Moment.

FTC sues PBMs over insulin pricing, a House bill would extend telehealth flexibilities, and HRSA awards contracts for the new organ transplant system.

As the Medicare Advantage (MA) Annual Enrollment Period (AEP) is fast approaching, let us imagine a future where Artificial Intelligence (AI) plays a much bigger role in the health plan sales process.

CVS to roll out co-located Oak Street Health clinics amid reduced profit outlook, CMS finalizes inpatient payment rule that includes new mandatory bundled payment model, and an appeals court gives providers another win in No Surprises Act litigation.

For Medicaid plans that enjoyed a surge in business during the pandemic, this rapid decline in the market may be disheartening, and the large rapid shifts in the Medicaid risk pools will be challenging to manage to target profit margins in the near-term.

Following the US Senate Finance Committee’s recent white paper on Medicare physician payment reform, the graphic shows how Medicare payments to physicians have not kept pace with inflation.

Ozempic trial shows the drug slows kidney disease progression, a blood-based colorectal cancer test is endorsed for FDA approval, and nursing home trade groups sue over the new staffing mandate.

In recent years, the Medicare Advantage (MA) program enjoyed both rapid membership growth and positive attention from healthcare organizations and advocates. As of the beginning of 2024, 33.4 million Americans were enrolled in MA, up 7% from 2023.

U.S. employers have played a dual role in the health insurance of their employees – both paying for their health insurance coverage and choosing their health insurance options. These two roles have been tied at the hip, but now, ICHRA (individual coverage Health Reimbursement Arrangement) products offer an opportunity to bifurcate that role.

Health system leaders focused on the day-to-day needs of their organization can sometimes lose sight of key developments in other sectors of healthcare. But in an interconnected healthcare ecosystem, understanding the trendlines their payer counterparts are facing is an essential task.

The Health Insurance Exchange (HIX) or Marketplace segment can be considered the largest growth market in the payer sector after Medicare Advantage (MA). From a relative low of 11.4 million members in 2020, the HIX market grew to 16.4 million members in 2023.

The latest Kaufman Hall Report includes an inside look at strategies for successful payer-provider partnerships in a rapidly changing macroeconomic climate.