Providers, facilities and air ambulances won 88% of disputes in the first half of 2025. In January, CMS released independent dispute resolution data from the first and second quarters of 2025, including details on disputing parties and payment determinations. The…
Research & Analysis
ACA plans are too expensive for the majority of Americans, according to a study published Jan. 6 in Medical Care. With enhanced subsidies still in limbo, the study relied on Commonwealth Fund definitions to evaluate unaffordability: At least 10% of…
Sustained GLP-1 use slows medical cost growth, according to findings published Jan. 13 from professional services firm Aon. The firm analyzed 192,000 GLP-1 users from July 2022 to March 2025, comparing outcomes to non-users, through commercial medical and pharmacy claims…
Ninety-three percent of health plan executives anticipate AI will contribute value by automating prior authorizations, according to an analysis of Deloitte survey results released Jan. 15. The Deloitte Center for Health Solutions surveyed more than 100 C-suite leaders across healthcare,…
Through a collaboration with Evolent — a health technology company focused on managing complex care — Florida Blue achieved a 40% drop in hospital and emergency room visits for Medicare Advantage members with cancer, according to a Jan. 14 news…
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Forty-six percent of New Yorkers would not be able to take on an unanticipated $1,000 medical bill without going into debt, according to a Jan. 12 MetroPlusHealth Care Crunch Index survey. MetroPlusHealth surveyed 1,010 adults across the five boroughs and…
A team of Stanford (Calif.) University researchers specializing in health law, AI, ethics and medicine identified “risks of supercharged flaws” in harnessing AI for prior authorization in a Jan. 6 Health Affairs report. Prior authorization is a longstanding sore spot…
From $1 trillion in Medicaid cuts courtesy of the One Big Beautiful Bill Act to workforce shortages, Medicaid home- and community-based services are under pressure. KFF evaluated payment rates, provider closures and staffing issues through a 2025 survey. All states,…
Affordability is a persistent struggle with employer-sponsored health insurance, according to 2024 data published in December by the University of Minnesota’s State Health Access Data Assistance Center. The data brief relied on the Agency for Healthcare Research and Quality’s Medical…
Negotiated prices for 10 Medicare Part D drugs will go into effect Jan. 1, 2026, which could lead to $1.5 billion in out-of-pocket savings, according to a December AARP Public Policy Institute report. The negotiations stem from the Inflation Reduction…