Last month, the Centers for Medicare & Medicaid Services (CMS) released its 2026 Medicare Advantage (MA) Rate Announcement, projecting a 5.06% average increase in payments to MA plans. That’s a notable jump from the 3.70% increase we saw in 2025. More than just a financial adjustment, this signals growing confidence in the Medicare Advantage model—and with it, growing expectations.
What does this mean simply? Insurance companies offering these plans will receive more government funding,
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Health IT | News, Analysis, Insights - HIT Consultant
ZeOmega Partners with Massachusetts Health Data Consortium to Launch Nation’s First Statewide FHIR-Based Prior Authorization System
What You Should Know:
- ZeOmega®, a population health and interoperability technology company announced it has been selected by the Massachusetts Health Data Consortium (MHDC), a nonprofit advancing health data sharing, to transform prior authorization and clinical data exchange across Massachusetts.
- The initiative creates the nation’s first statewide FHIR®-based system designed to streamline communication between payers and providers, reducing administrative burdens and
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What Are Healthcare’s Most Pressing Revenue Integrity Issues in The Remote-Work Era?
With more and more organizations merging for scale and sustainability, revenue cycle teams are being centralized, taking these critical personnel further away from physicians at the bedside. Remote teams are finding it harder than ever to collaborate with clinicians on critical functions.
Simultaneously, more revenue cycle functions are being automated as robotic process automation and generative AI evolves. With fewer administrative personnel in general — and even fewer
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CMS Launches Cell and Gene Therapy (CGT) Access Model for Medicaid Sickle Cell Patients
What You Should Know:
- The Centers for Medicare & Medicaid Services (CMS) launches its Cell and Gene Therapy (CGT) Access Model, a new approach to delivering cutting-edge treatments for people on Medicaid living with sickle cell disease.
- A total of 33 states, plus the District of Columbia and Puerto Rico, will participate in this model, collectively representing approximately 84% of Medicaid beneficiaries with the condition, significantly expanding access to
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New Strategies Needed: No Surprises Act and the Challenges for Payors with Provider Data Inaccuracies
With more than 20 years of experience at a major health insurance company, I’ve seen firsthand how challenging provider data management can be. I’ve worked with teams reconciling files from delegated groups, fielded calls from frustrated providers, and navigated compliance pitfalls that can quickly become operational headaches. But the stakes have never been higher than they are now under the No Surprises Act (NSA).
For years, maintaining an accurate provider directory was considered a best
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Elsevier’s Clinician of the Future 2025 Report: AI’s Rapid Ascent in Healthcare Amidst Clinician Pressures
What You Should Know:
- The 4th annual Elsevier Clinician of the Future report reveals a remarkable acceleration in the adoption and impact of Artificial Intelligence (AI) in healthcare.
- Based on a global survey of over 2,000 clinicians, the report highlights AI's growing role in addressing persistent challenges like clinician burnout, increasing patient demand, and fragmented care, while also shedding light on evolving perceptions and regional differences.
Current State
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Ultrahuman Launches Blood Vision Nationwide, Enhances Health Tracking with Wearable Data Integration
What You Should Know:
- Ultrahuman, the pioneering health optimization company behind the Ultrahuman Ring and M1 (an advanced Continuous Glucose Monitoring platform), today announced the nationwide expansion of Blood Vision, now available across 48 U.S. states.
- Unlike traditional blood testing services that offer static snapshots, Blood Vision combines deep biomarker analysis with real-time wearable data to create the most advanced consumer-facing system for longitudinal health
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Boost Medicare Star Ratings: A Strategic Game Plan for Health Plans
As they navigate complex times, health insurers have their eye on two important financial indicators. And both are moving in the wrong direction. Costs are on the rise while Medicare Star Ratings are on the decline.
Separate but related, the two trends converge on the same idea: health plans need to enable higher quality care at a lower price.
If it sounds like a Herculean feat, that’s because it is. But some health plans are making it happen.
While some of the cost pressures—for
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Fruit Street Health Cleared: SEC Investigation Concludes with No Action
What You Should Know:
- Fruit Street Health announced that it has received a letter from the Securities and Exchange Commission ("SEC") confirming the conclusion of the SEC's investigation into the company. The letter states that the SEC enforcement staff does not intend to recommend any action by the SEC against Fruit Street Health.
- This announcement allows Fruit Street Health to continue its focus on its public benefit mission: serving the 1 in 3 Americans with prediabetes and
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evolvedMD Secures $34M to Expand Integrated Behavioral Health Care Nationwide
What You Should Know:
- evolvedMD, a Collaborative Care Management (CoCM) provider, announced the close of its $34M Series B investment round, led by Sustainable Investing at Goldman Sachs Alternatives. Existing investors Conductive Ventures, FCA Venture Partners, Healthworx Ventures, Tectonic Ventures, and Waterline Ventures also participated in the round.
- The funding will be used to accelerate evolvedMD's mission to increase behavioral health care availability and expand
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