Health Plan Resources

A collection of resources to help health plan leaders navigate the challenges and opportunities in this new era of health care.

Resources

Podcast | Social Determinants of Health

An epidemiologist discusses how we failed the public when it comes to public health
Dr. Brian Castrucci, an epidemiologist and CEO of the de Beaumont Foundation, talks with HFMA President and CEO Joe Fifer about policies to improve public health, cost effectiveness of health, the future of COVID-19 and the healthcare indus...
Save
Article | Innovation and Disruption

Healthcare venture investing: How to succeed in a white-hot market
U.S. health systems can best promote cost effectiveness of health through innovation and a commitment to ensuring the ongoing financial sustainability of the healthcare enterprise. Health systems are increasingly turning to venture investin...
By David G. Anderson, PhD, Mary Jo Potter, and Dudley E. Morris
Save
News | Medicaid Payment and Reimbursement

Healthcare provisions in massive legislation could improve care access but also reduce federal funding for some hospitals
In pending legislation, reductions to disproportionate share hospital payments would be used to subsidize commercial insurance for low-income residents of states that haven’t expanded Medicaid.
By Nick Hut
Save
News | Medicare Payment and Reimbursement

CMS cancels regulations that would ensure coverage of breakthrough medical devices, but new legislation could fill the void
Citing patient safety concerns among other issues, CMS formally canceled a Trump administration rule that would have required Medicare to cover breakthrough medical devices.
By Nick Hut
Save
News | Medicaid Payment and Reimbursement

Healthcare provisions in massive legislation could improve care access but also reduce federal funding for some hospitals
In pending legislation, reductions to disproportionate share hospital payments would be used to subsidize commercial insurance for low-income residents of states that haven’t expanded Medicaid.
By Nick Hut
Save
News | Medicare Payment and Reimbursement

Medicare's 2022 payment rule for physician services adds to a significant impending cut
CMS used the 2022 final rule for Medicare physician payments to offer accommodations on policies related to telehealth and more, but concerns loom about a large cut that's in the offing.
By Nick Hut
Save
Blog | Administrative Simplification

Research highlights ways to save more than $250 billion per year through healthcare administrative simplification
Savings can be generated at the organizational and healthcare industry levels through steps to reduce wasteful administrative processes, study authors wrote.
By Nick Hut
Save
Blog | Health Plan Payment and Reimbursement

Hospitals and Congress propose improvements to prior authorization processes in Medicare Advantage
The American Hospital Association says pending regulations that would affect prior authorization should be expanded to include Medicare Advantage.
By Nick Hut
Save
Blog | Healthcare Business Trends

Latest financial metrics indicate continuing challenges for hospitals
As COVID-19 hospitalizations increased, some volumes took a hit and margins remained tight.
By Nick Hut
Save

Shall We Play a Game?