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RADAR on Medicare Advantage
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Following up on promises to root out fraud, waste and abuse in government-sponsored programs, CMS on May 21 stunned the industry with a bold plan to rapidly expand risk adjustment data validation audits (RADV) used to collect overpayments from Medicare Advantage plans. And on May 30, CMS...
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As artificial intelligence plays an increasingly prominent role in health care and other industries, Medicare Advantage organizations are exploring the myriad ways AI can safely support care management and quality improvement activities while driving operational efficiency. During a recent...
HEALTH PLAN WEEKLY
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In J.D. Power’s 2025 U.S. Commercial Member Health Plan Study, the company highlighted a widening gap between the highest and lowest performing health plans, which lays bare some increasingly meaningful differences in how members perceive the service, communication and value they’re receiving. According to J.D. Power, part of what may be driving that trend is a virtuous — rather than vicious — cycle.
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Elevance Health, Inc. saw increased health care utilization among its Affordable Care Act exchange members in April, according to CEO Gail Boudreaux, who spoke on May 28 during the Bernstein Strategic Decisions Conference. However, Elevance in a Securities and Exchange Commission filing on the same day reaffirmed its financial guidance for 2025.
Radar On Speciality Pharmacy
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While it appears unclear whether the administration is intending for most-favored nation (MFN) pricing to apply to commercial health plans, most stakeholders agree that it would be extremely difficult to do. But if the administration is successful in putting MFN into effect in at least Medicare, private insurers could feel the impact.
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The advanced therapies market shows no signs of slowing, as scientific innovation continues to bring revolutionary new treatments out of the laboratory and onto the U.S. market. But some barriers to access, including the lack of patient caregiver support, payer hurdles and high costs, still remain and must be overcome if these agents are able to realize their potential and be even more impactful than they already are, according to a recent report from Cardinal Health.
RADAR ON DRUG BENEFITS
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A survey from the Pharmaceutical Strategies Group (PSG) released on June 10 found that 90% of health plans and employers were moderately or very concerned about the affordability of GLP-1 medications for obesity...
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Medical professionals with track records of spreading vaccine misinformation are among HHS Secretary Robert F. Kennedy Jr.’s eight new appointments to the Centers for Disease Control and Prevention’s Advisory Committee...
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AIS Health is a publishing and information company that has served the health care industry for more than 30 years. Our mission is to provide our readers with an actionable understanding of the business of health care and pharmaceuticals. Our in-depth writing covers the companies, people, catalysts and trends that create the richly textured contours of the health care and drug industry. AIS Health maintains journalistic independence from our parent company, MMIT. We are committed to integrity in reporting and bringing transparency to health industry data.
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