The proposed Requiring Enhanced and Accurate Lists (REAL) Health Providers Act—also referred to as the RHP Act—recently signed and expected to take effect for plan year 2028, represents a significant shift in how healthcare providers are regulated, credentialed, and represented to Medicare Advantage members.
The proposed requirements aim to provide health plan members with greater transparency, accessibility, and accuracy within provider directories in their member portals. Payers will need
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Healthcare Policy Regulation & Reform | News, Analysis, Insights - HIT Consultant
When Rural Maternity Care Fails: Why Bipartisan Policy Must Stabilize Obstetric Infrastructure
More than one-third of U.S. counties are now considered maternity care deserts. In 2023, the national maternal mortality rate hit 18.6 deaths per 100,000 live births. For Black women, that climbs to 50.3 deaths per 100,000, more than double the national average.
What we're missing is policy alignment, sustainable funding, and important culture changes that align maternal care teams beyond the current boundaries of what high quality and reliable maternal care looks like. And we can’t
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Building Bridges: Academic-Practice Partnerships as the Future of New Graduate Nurse Preparedness
Building Bridges: Academic-Practice Partnerships as the Future of New Graduate Nurse Preparedness
The nursing workforce is at an inflection point. As experienced nurses retire or leave the profession and care delivery continues to shift in complexity, health systems are increasingly dependent on new graduate nurses to sustain operations, ensure patient safety, and deliver high‑quality care. Many organizations are finding that today’s graduates are entering practice underprepared for the
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UnitedHealthcare to Eliminate 30% of Prior Authorizations by Year-End: A Strategic Shift Toward Transparency and Rural Support
What You Should Know
UnitedHealthcare (UHC) will eliminate an additional 30% of prior authorization requirements by the end of 2026, targeting outpatient surgeries, diagnostic tests (like echocardiograms), and chiropractic care.The initiative aims to reduce administrative friction, as 92% of current authorizations are already approved, typically in under 24 hours.UHC is expanding its National Gold Card Program, which exempts provider groups with proven track records of evidence-based care
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The Medicaid Maternity Cliff: 84% of Health Plan Leaders Expect Major Care Disruption in 2026
What You Should Know
Sage Growth Partners has released its Q1 2026 report, "The Medicaid Maternity Cliff," identifying a looming crisis in maternal and infant healthcare access.52% of Medicaid-enrolled mothers expect to lose their coverage due to eligibility redeterminations, while 84% of health plan leaders anticipate moderate to severe care disruption.The report identifies significant clinical risks, with 72% of leaders citing delayed or avoided prenatal and postpartum care as a primary
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ECRI Urges Congress to Strengthen Regulatory Transparency for Digital Health and CDS Tools
What You Should Know
ECRI, a nonprofit patient safety organization, submitted formal recommendations to the House Energy and Commerce Subcommittee on Health in April 2026.The organization warns that many general wellness devices—measuring vitals like blood pressure and glucose—lack FDA oversight and clinical validation, creating "invisible" risks for users.ECRI raised concerns regarding the Digital Health Screeners Act of 2026, specifically citing the lack of mandatory reporting for
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6 Strategies to Help Meet HR1 Eligibility and Enrollment Requirements
HR1, also known as the One Big Beautiful Bill Act, significantly revised eligibility and enrollment processes for Medicaid and the Supplemental Nutrition Assistance Program (SNAP) benefits. With deadlines starting December 31, 2026, agencies must begin modernization efforts now to prevent costly delays.
Health and human service agencies must take a thoughtful approach to these policy updates to help ensure compliance while continuing to deliver quality services. Six strategies include:
1.
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Finding the Right Five Percent: How Machine Learning Is Reshaping Care Management
Population Health Has a Precision Problem
Population health programs continue to rely on blunt tools. Many risk stratification approaches emphasize historical utilization—basic risk scores or vendor-generated models that explain who was expensive—rather than identifying emerging clinical risk. These methods struggle to detect deterioration early enough to influence outcomes.
At the same time, care management teams face persistent resource constraints. Organizations cannot provide intensive
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J.D. Power: Why Medicare Advantage App Usage is Plummeting While Commercial Adoption Soars
What You Should Know
The Study: J.D. Power has released its 2026 U.S. Healthcare Digital Experience Study, measuring member satisfaction across five factors: visual appeal, navigation, information/content, speed, and telehealth.The Winners: Cigna Healthcare ranked highest among commercial plans (for the second consecutive year), followed by Premera Blue Cross and UnitedHealthcare. UPMC Health Plan took the top spot for Medicare Advantage (also its second consecutive win), followed by
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Cityblock Health CEO Dr. Toyin Ajayi Releases Blueprint for AI in Medicaid
What You Should Know
The Manifesto: Dr. Toyin Ajayi, CEO of Cityblock Health, has published a comprehensive report, “Medicaid + AI: A New Standard for Innovation,” arguing that the nation's most vulnerable patient population must be the proving ground for generative AI.The Investment Disconnect: Currently, roughly 60% of healthcare AI investment is directed toward revenue cycle management, billing optimization, and risk adjustment. Conversely, less than 20% of health plans use AI to develop
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