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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Healthcare Policy Regulation & Reform | News, Analysis, Insights - HIT Consultant
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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How CMS Policy Just Shifted 30% of Shoulder Surgeries Out of the Hospital
A Shoulder Replacement Case Study
The Bottom Line: When CMS makes a procedure ASC-payable, the shift is fast, measurable, and concentrated in certain territories. Here's what total shoulder arthroplasty can tell us about where the site-of-service mix for hundreds of procedures is headed.
In July, I broke down the 2026 OPPS Proposed Rule and called it a gold rush. The first tranche just hit: 285 procedures came off the inpatient-only list on January 1. The remaining 1,400+ will phase out by
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How In-Home Care Supports Healthy Aging at Home
With age comes new challenges and opportunities. As people grow older, a desire to stay in place is common; individuals want to remain in familiar surroundings as they grow older. That is why in-home care services are so important and needed, as they provide people the support they need to accomplish this goal. These services promote dignity, comfort, and independence by providing assistance with daily activities and companionship.
Promoting Independence and Confidence
Senior home care in
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CMS Updates MIPS for 2026: Administrative Claims, TEFCA Bonuses, and AI Safety Measures
MIPS (Merit-based Incentive Payment System), a Medicare program that rewards clinicians for delivering high-quality, cost-efficient care, is by nature an evolving entity.
Much the way healthcare continually changes as new knowledge, treatments, and technologies modify past practices, MIPS is ever-changing, with program updates, revisions, and new requirements.
While these changes are well-intentioned and support value-based healthcare, they don’t necessarily make it easier for
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