providers

Lawsuit: Like a “boa constrictor,” UnitedHealthcare squeezed anesthesia group out of competition

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U.S. Anesthesia Partners has filed lawsuits against UnitedHealthcare in Colorado and Texas, accusing the payer of forcing it out of network and intentionally interfering with its relationships with providers in those states. But, according to UnitedHealthcare, the lawsuits are an attempt to get the insurer… Read More »Lawsuit: Like a “boa constrictor,” UnitedHealthcare squeezed anesthesia group out of competition

Providers look to predictive modeling to help rebuild finances in 2021

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After a challenging 2020, health systems are looking to deploy strategies for recovery, especially to bolster financial health. One strategy health executives are considering is investing in predictive modeling technology that can help them manage patient demand and outcomes in the coming year.

Biden to reopen ACA marketplaces for 3 months

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The Biden administration established a special enrollment period to give uninsured Americans a chance to sign up for insurance on the HealthCare.gov markets. Providers and payers applauded the announcement, but it remains to be seen whether the move will encourage people to get insured.

CMS proposed rule requires payers to streamline prior authorizations

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The rule would require payers in the Medicaid, CHIP and QHP programs to build and maintain application programing interfaces to improve data exchange and the prior authorization process. But the rule does not include Medicare Advantage plans, which the American Hospital Association called “disappointing.”

CMS’ new Geo care delivery model: 5 things to know

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The new Geographic Direct Contracting Model aims to improve quality of care and slash costs for Medicare beneficiaries across an entire region. It involves setting up risk-sharing arrangements where participants will be responsible for the total cost of care for beneficiaries in the region.