The recent cyberattack on Change Healthcare affected clinical-decision support, eligibility verifications, chart abstractions, and pharmacy operations, and has highlighted vulnerabilities within the industry’s digital infrastructure. In light of these disruptions, plans need to explore the broader implications, particularly concerning Part D, CAHPS, Star Ratings, and the overall operational and financial health of provider networks. Impact…

Background A quick search online will show that most individuals go into the field of nursing for similar reasons; the National Institutes of Health (NIH) sums it up nicely, citing nurses have “…a desire to serve others…a personal calling…and a desire to work in the [healthcare] field with the sick, in a noble and caring…

A Maryland firm that oversees the nation’s largest independent network of primary care medical practices is facing a whistleblower lawsuit alleging it cheated Medicare out of millions of dollars using billing software “rigged” to make patients appear sicker than they were. The civil suit alleges that Aledade Inc.’s billing apps and other software and guidance…

Systemic racial biases persistently shape the health care experiences of Black, Latinx and Indigenous populations. These biases are especially pronounced for women of color, influencing everything from diagnosis and family planning to treatment recommendations. In fact, Centers for Disease Control and Prevention data show that Black women are two to three times more likely to…

Controlling costs is a key Value-Based Care goal, a fact well-known to ACOs that share savings with CMS. Even as individual ACOs have generated tens of millions of dollars in savings, however, MSSP ACOs as a whole have only been able to reduce their Total Cost of Care (TCOC) by a fraction. That is a…

Since the implementation of the Affordable Care Act, a major shift has been underway in how individuals in traditional Medicare receive their services. The Centers for Medicare and Medicaid Services (CMS) has been systematically developing programs that focus on providing value-based care (VBC) to these enrollees. These programs include the Medicare Shared Savings Program (MSSP);…

Insurtech Alignment Healthcare has recorded $1.82 billion in revenue for full-year 2023 and beat market expectations for quarterly revenue by more than $20 million, the company announced Feb. 27 during its 2024 fourth-quarter earnings call. However, its earnings per share was a loss of 25 cents, falling short of Wall Street expectations of a loss of…