3+ week, 2+ day ago (93+ words) Solera Health is working to streamline employer contracting with health tech. Solera Health Chief Commercial Officer Glenn Alphen offered an overview of how the company seeks to streamline the way employers contract with health tech companies. Chief Product Officer Kris Heinzen talked about a program to identify potential high-cost utilizers in the network as well as improve navigation to connect people with the right services to support their primary and specialty care needs. Heizen also referenced an extension of its network into four different intervention types: wellness, condition management, therapy, and specialty....

1+ week, 5+ day ago (667+ words) For years, utilization management (UM) was quietly delegated away for scale, speed, and supposed efficiency. But today, health plans are hitting the breaking point. What's emerging isn't just a call for reform; it's a clear shift in strategy: reclaim control, intelligently. How Apella leverages technology to increase OR efficiency. Delegating UM to vendors once made sense. Health plans needed to scale. Vendors offered niche expertise and infrastructure. But that efficiency came at a cost: clinical opacity, siloed workflows, inconsistent decisions, and rising provider abrasion. Long-term contracts locked in legacy systems, leaving many health plans unable to respond to evolving regulations or internal priorities. In the process, health plans forfeited visibility into one of the most consequential functions of care delivery, prior authorizations. Strategic insourcing isn't a reversion, it's a redesign Solera Health is working to streamline employer contracting with health…...

1+ week, 3+ day ago (1440+ words) About 22 million Americans would face sharply higher healthcare costs if enhanced ACA tax credits expire at the end of the year. Experts warn that the impact would extend beyond just families relying on ACA courage " also straining hospitals, increasing uncompensated care and potentially costing the economy hundreds of thousands of jobs. It's been a week since the nation's longest-ever government shutdown ended, but millions of Americans still don't know whether they'll be able to afford their healthcare coverage next year. The shutdown finally ended November 12 when a funding bill was signed into law. Notably absent from the law was any extension of the enhanced Affordable Care Act (ACA) subsidies that 24 million Americans rely on to keep their premiums somewhat affordable. Enhanced ACA tax credits were introduced during the pandemic to expand healthcare affordability, and they are set to expire at…...

3+ week, 5+ day ago (915+ words) The billionaire Mark Cuban whose Cost Plus Drugs company has been shaking up the world of prescription drug coverage minces no words when it comes to the role of employers in bringing down healthcare costs. But some employers believe he is wrong. He has charged employers of being complicit. It was a theme that he returned to in his main stage appearance at the recently concluded HLTH conference that draws many prominent healthcare executives to Las Vegas annually. Greenway Health blends smart technology with human expertise to elevate revenue cycle. It's important to note that 154 million Americans get health insurance from their employers and, of those, 63% are covered by self-insured employers. These are no small numbers for sure. But is Cuban right? "No," said Darcy Sementi emphatically as the gathered HLTH audience in the room broke out in laughter. Sementi,…...

14+ hour, 7+ min ago (195+ words) Greenway Health blends smart technology with human expertise to elevate revenue cycle. If HSAs and FSAs were functioning as originally intended, the rising out-of-pocket costs faced by most Americans would be met with increased financial fluency and agency." However, we have seen the opposite occur. More than half of employees in the U.S. are covered by high-deductible health plans, meaning millions of people are paying the first several thousand dollars of their healthcare costs themselves. Yet, they are forced to navigate insurer rules and administrative portals before they are able to access the money they have already set aside for their own care. In an interview, Munich Re Specialty Senior Vice President Jim Craig talked about the risk that accompanies innovation and the important role that insurers play. Alan Murray on improving access for medical transportation. AI-native tax firm Gelt combines…...