For payer organizations, the new CMS prior authorization final rule isn’t a simple compliance checkbox. It’s a real-time audit of your operational readiness, digital infrastructure, and member-facing workflows. The deadline may be regulatory, but the pressure is strategic. And while the rule becomes enforceable in 2026, your clock starts now. Here’s what you need to...
In today’s complex healthcare landscape, effective care management requires seamless coordination across multiple disciplines, including care management, utilization management, care coordination, disease management, and population health management. Automated solutions enhance efficiency, but without well-structured workflows, even the most sophisticated technology can fall short of delivering optimal outcomes.
A recent study published in JAMA Network Open suggests that physician groups operating under at-risk Medicare Advantage (MA) payment models (2-sided risk) may be delivering higher-quality, more efficient care than their fee-for-service (FFS) counterparts.
For healthcare organizations and providers involved in a Medicare Shared Savings Program (MSSP), 2025 is truly a time of transition and a little uncertainty. When colleagues recently asked for my thoughts on MSSP this year, the old saying “May you live in interesting times” kept coming to mind.
