Accountable alternative payment models held steady in 2024, according to a Feb. 2 survey by America’s Health Insurance Plans. In 2024, 44.9% of healthcare payments stemmed from alternative payment models that ensure provider accountability for quality and cost of care.…
Research & Analysis
Cancer survivors enrolled in high-deductible health plans had significantly worse overall and cancer-specific survival than those in standard health plans, according to a study published Jan. 29 in JAMA Network Open. The researchers analyzed data from 147,254 adults ages 18…
Prior authorization ranks as the single biggest burden insured Americans face when navigating the healthcare system, according to a KFF Health Tracking Poll published Feb. 2. The poll was conducted Jan. 13-20 among 1,426 U.S. adults. Five things to know:
Medicare Advantage insurers will likely continue to scale back supplemental benefits and exit certain markets if CMS finalizes its proposed 0.09% payment increase for 2027, according to a Jan. 30 analysis from Fitch Ratings. “Depending on finalized payment rate and…
Participating Medicare Part D plans can officially begin covering weight-loss treatment in 2027. The initiative falls under CMS’ voluntary “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” — or BALANCE — model. The December news followed President Trump’s negotiations…
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Medicare Advantage insurers made almost 53 million prior authorization decisions in 2024, according to a Jan. 28 KFF analysis. KFF relied on insurer data reported to CMS, focusing on service determinations, not claims determinations for services already provided. Withdrawn and…
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…
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,…