Medicare Advantage Prior Authorizations: Lower Denial Rates, But Persistent Issues
Medicare Advantage prior authorization practices, though controversial, have lower denial rates (6.4 percent in 2023) than perceived; however, appeals are frequently successful (over 80 percent), and the system causes significant administrative burdens.
Medicare Advantage Prior Authorizations: Lower Denial Rates, But Persistent Issues
Medicare Advantage prior authorization practices, though controversial, have lower denial rates (6.4 percent in 2023) than perceived; however, appeals are frequently successful (over 80 percent), and the system causes significant administrative burdens.
Progress
52% Bias Score
Elevance Health Acquires Indiana University Health Plans, Expanding Medicare Advantage Presence
Elevance Health acquired Indiana University Health Plans, adding 28,600 members (19,000 Medicare Advantage and 9,600 commercial) to its Anthem Blue Cross and Blue Shield operations in Indiana, reflecting a national trend of hospital systems exiting the insurance market and increasing consolidation i...
Elevance Health Acquires Indiana University Health Plans, Expanding Medicare Advantage Presence
Elevance Health acquired Indiana University Health Plans, adding 28,600 members (19,000 Medicare Advantage and 9,600 commercial) to its Anthem Blue Cross and Blue Shield operations in Indiana, reflecting a national trend of hospital systems exiting the insurance market and increasing consolidation i...
Progress
48% Bias Score
Public Anger at Health Insurers Despite Positive Ratings
Public reaction to the murder of UnitedHealthcare CEO Brian Thompson revealed deep anger towards health insurers despite a KFF survey showing that most Americans rate their health insurance positively; this highlights the perverse financial incentives in the system, favoring profit over patient care...
Public Anger at Health Insurers Despite Positive Ratings
Public reaction to the murder of UnitedHealthcare CEO Brian Thompson revealed deep anger towards health insurers despite a KFF survey showing that most Americans rate their health insurance positively; this highlights the perverse financial incentives in the system, favoring profit over patient care...
Progress
52% Bias Score
2024 Healthcare: Mergers Rise, Politics Silent, MA Enrollment Grows
In 2024, the US presidential election largely ignored healthcare, while hospital mergers increased, Medicare Advantage continued growing, and digital health funding decreased; however, new startups emerged.
2024 Healthcare: Mergers Rise, Politics Silent, MA Enrollment Grows
In 2024, the US presidential election largely ignored healthcare, while hospital mergers increased, Medicare Advantage continued growing, and digital health funding decreased; however, new startups emerged.
Progress
44% Bias Score
Medicare Advantage Insurer, Analytics Firm Pay $100 Million in Fraud Settlement
A Western New York health insurer, Independent Health, and its data analytics partner, DxID, will pay $100 million to settle Justice Department allegations of fraudulent billing for exaggerated or nonexistent health conditions in their Medicare Advantage plans, highlighting vulnerabilities in the sy...
Medicare Advantage Insurer, Analytics Firm Pay $100 Million in Fraud Settlement
A Western New York health insurer, Independent Health, and its data analytics partner, DxID, will pay $100 million to settle Justice Department allegations of fraudulent billing for exaggerated or nonexistent health conditions in their Medicare Advantage plans, highlighting vulnerabilities in the sy...
Progress
48% Bias Score
"Healthcare Transformation: Overcoming Interoperability and Operational Inefficiencies Through AI Augmentation"
"SCAN Health Plan's CEO, Dr. Sachin Jain, highlights three key challenges hindering healthcare transformation: interoperability, real-time digital infrastructure, and meaningful transparency. He advocates for AI augmentation of human capabilities, focusing on integration to enhance the member experi...
"Healthcare Transformation: Overcoming Interoperability and Operational Inefficiencies Through AI Augmentation"
"SCAN Health Plan's CEO, Dr. Sachin Jain, highlights three key challenges hindering healthcare transformation: interoperability, real-time digital infrastructure, and meaningful transparency. He advocates for AI augmentation of human capabilities, focusing on integration to enhance the member experi...
Progress
40% Bias Score