National Reports-As next year's Health Insurance Portability and AccountabilityAct (HIPAA) deadline to begin filing claims electronically looms closer,healthcare providers are scrambling to fund and establish clinical informationsystems. A recent Wall Street Journal poll found that only 10% of hospitalshave such capabilities, and 27% in another survey said they lacked the financialresources to establish them.
Expect Democrats to flex their oversight powers even if President Donald Trump’s veto power blocks their efforts to reverse Medicaid cuts or restore enhanced ACA subsidies. The administration’s most-favored-nation policies and HHS Secretary Kennedy will probably be in the hot seat.
Health plans should be using data, digital tools and human support to identify potential disruptions early, and whether a member is changing plans or managing a new health condition, the experience should feel guided rather than overwhelming.
Pretax adjusted income from operations from Express Scripts, Cigna's pharmacy benefit manager, fell by 21.5% compared with the third quarter of 2025, while income from operations of its specialty drug business jumped by 15%.
Annesha White, Pharm.D., M.S., Ph.D., and Fredrick Manasseh, Pharm.D., MBA, BCGP, explain where AI helps managed care pharmacy, where bias creeps in and what skills pharmacists need to oversee it.
Value-based care has scored some cost-saving successes, says Christopher Stanley, M.D., MBA, president of Henry Ford Health's Populance. Health systems that build their own value-based care strategy, rather than adopting particular models one by one, will be in the best position to succeed, he says.
The second half of our conversation with Christopher Stanley, M.D., MBA, the president of Henry Ford Health's Populance and the newest member of the Managed Healthcare Executive editorial advisory board.
The first part of our conversation with Christopher Stanley, M.D., MBA, the president of Henry Ford Health's Populance and the newest member of the Managed Healthcare Executive editorial advisory board.
