article thumbnail

Prior Authorization Takes a Leap Forward in CMS Regulation

Healthcare IT Today

The Centers for Medicare & Medicaid Services (CMS) have taken a bold step by mandating a standard for prior authorization. I talked to Nikki Henck, Senior Director of Utilization Management at Sagility , about the implementation and potential impact of this proposed requirement, which, if finalized, will be enacted in January 2026.

article thumbnail

The $4 Trillion Health Economy of 2020

Health Populi

Three factors will drive healthcare costs to 2026: prices for medical goods and services, changes in income growth, and shifting enrollment from private health insurance to Medicare — driven by the aging of Boomers. trillion in 2026 when healthcare spending will be $1 in every $5 in the American economy (approaching 20%).

Insiders

Sign Up for our Newsletter

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

article thumbnail

The 2023 Health Economy – The Evolving Primary Care and Retail Health Convergence Through Trilliant Health’s Lens

Health Populi

healthcare spending, with curves moving up and to the right, and the Medicare Hospital Insurance Trust Fund moving into the opposite direction toward insolvency by 2033. In particular, 21% of consumers with medical debt say the primary source of that debt was due to the bills from doctor visits.

article thumbnail

Health Provider News

Hall Render

Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ million expansion ‘Very, very unusual.’

article thumbnail

Prior Authorization and Interoperability – Changing the Dynamics of Medicare

HIT Consultant

Don Rucker, MD – Chief Strategy Officer, 1upHealth CMS and Medicare are trying to change the dynamics of American healthcare. For the last 20 years, Medicare Fee for Service has been the hotspot of spending and value. Now fast forward to today and Medicare Advantage has more beneficiaries.

article thumbnail

As Medical Cost Trend Remains Flat, Patients Face Growing Health Consumer Financial Stress

Health Populi

Even with moderating medical trend growth, the Centers for Medicare and Medicaid Services (CMS) expect that healthcare spending will account for 20% of the U.S. economy by 2026. As with public sector healthcare spending (“entitlements” in the form of Medicare and Medicaid), healthcare spending crowds out U.S.

article thumbnail

Health Provider News

Hall Render

to Recruit, Train Primary Care Students UAMS Gets $17.5M to Recruit, Train Primary Care Students UAMS Gets $17.5M to hospitals Propella Therapeutics, Pittsboro firm with 5 employees, sold for $175M Winston-Salem’s clinical research organization Javara raises $9.43