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
Read More
Health IT | News, Analysis, Insights - HIT Consultant
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
Read More
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
Read More
CMS Proposes 2026 Physician Fee Schedule Rule: Boosting Primary Care, Cutting Waste, and Modernizing Payments
What You Should Know:
- The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule for the Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS).
- The proposal aims to increase quality care for Medicare recipients while significantly reducing unnecessary spending. Key initiatives include advancing primary care management through new quality measures, reducing waste in skin substitute spending, and introducing a new payment model focused on
Read More
Beyond Patient-Centric: The Rise of Evidence-Based, Content-Centric Care
he past decade has seen healthcare undergo a paradigm shift. Walking into a treatment room today, the dynamic with patients is fundamentally different from even a few years ago. No longer satisfied with passively receiving care, patients – in particular, younger generations like Gen Z – increasingly want a seat at the table. They want to be active, informed participants in all aspects of their health care. And the data backs this up. According to McKinsey, only 42% of Gen Z depend on doctors for
Read More
Omega Healthcare Expands Microsoft Collaboration, Launches 20+ AI Solutions to Transform Revenue Cycle Management
What You Should Know:
- Omega Healthcare, a provider of technology-enabled Revenue Cycle Management (RCM) services, today announced an expanded collaboration with Microsoft.
- Through the integration of Microsoft Azure's cutting-edge AI models via Azure AI Foundry and the company's proprietary Omega Digital Platform (ODP), Omega Healthcare has launched more than 20 generative and agentic AI solutions designed to enhance healthcare organizations' revenue cycle operations and
Read More
FTC Penalizes NextMed $150k for Deceptive Weight-Loss Claims
What You Should Know:
- The Federal Trade Commission (FTC) has reached a settlement with Southern Health Solutions, Inc., operating as Next Medical and NextMed, and its founders Robert Epstein and CEO Frank Leonardo III.
- The FTC's charges allege the telemedicine company used deceptive cost and weight loss claims, fake reviews, and undisclosed terms to lure consumers into their weight-loss membership programs.
Deceptive Weight-Loss Claims and Hidden Fees
According
Read More
Digital Lifelines: Fortifying Healthcare’s Cybersecurity Amid Budget Cuts
IT leaders in healthcare are no strangers to pressure. They are expected to safeguard sensitive patient data, maintain compliance, and ensure teams have the technology needed to support clinical operations amid shrinking budgets and rising cyber risks. Cybercriminals know this, and they’re exploiting it.
The U.S. remains the top targeted region for ransomware attacks against healthcare organizations. The wealth of sensitive data and life-or-death stakes make these organizations more likely
Read More
New AI Model Predicts Cancer Mutations from Routine Pathology Slides, Streamlining Treatment Decisions
What You Should Know:
- A new study by researchers at the Icahn School of Medicine at Mount Sinai, Memorial Sloan Kettering Cancer Center, and collaborators, suggests that artificial intelligence (AI) could significantly improve how doctors determine the best treatment for cancer patients by enhancing how tumor samples are analyzed in the lab.
- The compelling findings, published in the July 9 online edition of Nature Medicine, demonstrated that AI can accurately predict genetic
Read More
Providers & Payers: Prepare Now for CMS Prior Authorization Final Rule
The new administration shed light on policy issues at the top of providers’ lists for 2025. While topics like physician burnout and Medicare payment reform were included, unsurprisingly, prior authorization remains at the forefront, as proven by entities like the American Medical Association, who represent more than 270K providers. Improvements in the prior authorization and interoperability space have been historically stalled due to lack of standard data and public reports, as technology
Read More
