Posts Tagged ‘Payer’
You have the insights, converting them into measurable action is the challenge: Becker’s takeaways on the next phase of payer performance
The 2026 Becker’s Spring Payer Issues Roundtable brought together more than 500 executives for two days of focused discussion on the trends shaping the future of healthcare. Across sessions, panels, and conversations, familiar priorities surfaced: AI, value-based care, cost pressure, and digital transformation. But what stood out wasn’t just what was discussed. It was how the conversation has evolved. Payers are…
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The gap between insight and performance: What our Becker’s webinar revealed
Healthcare payers are operating under sustained margin pressure. Rising specialty drug costs, post-COVID utilization shifts, Medicaid and Medicare Advantage margin compression, and increasing quality expectations are all converging at once. At the same time, organizations have more data than ever before. So why isn’t performance improving at the pace it should? In our recent Becker’s Healthcare webinar, industry leaders shared their perspectives on this…
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Too many vendors, too little alignment: The challenge holding health plans back
Health plans don’t have a data problem. They have an action problem. Information from multiple domains, including claims, medical management, finance, network operations, quality, social risk, and customer experience, is spread across dozens of systems and vendors. This data is often isolated in separate environments, requiring your teams to piece together information from multiple sources just to understand what’s…
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Becker’s Payer Issues Webinar: Disconnected analytics are holding back payer MLR performance
The growing pressure on payer performance Healthcare organizations have more data than ever before yet achieving meaningful performance improvement has never been more difficult. Rising costs, specialty drug spend, and Medicare Advantage challenges are putting increased pressure on payer leaders to improve medical loss ratio (MLR) and overall margin performance. The solution isn’t more insights.…
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MedeAnalytics brings actionable insights to the Becker’s Spring Payer Issues Roundtable
The healthcare industry has reached a pivotal moment. Rising medical costs, tightening margins, increasing regulatory pressure, and the continued shift toward value-based care are forcing payers to rethink how they manage performance across the enterprise. Meanwhile, expectations for improved care quality, better member experience, and operational efficiency continue to grow. These challenges will be front…
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Helping Accountable Care Organizations Navigate the Perfect Storm
In the ever-evolving landscape of healthcare, Accountable Care Organizations (ACOs) find themselves at the epicenter of a transformative era. Recently, we facilitated an insightful dialogue with healthcare experts Lynn Carroll, COO of HSBlox, and Brian Norris, MBA, RN, FHIMSS, Vice President & Managing Director of Strategic Consulting at MedeAnalytics, to shed light on the future…
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Navigating the Medicare Landscape: Implications of the Latest Rule Changes for Healthcare Organizations
The Centers for Medicare & Medicaid Services (CMS) has recently unveiled significant proposed changes to Medicare Advantage (MA), Medicare Prescription Drug (Part D), and Medicaid programs. Announced on November 26, 2024, these updates aim to enhance affordability, transparency, and equity in healthcare delivery. The implications of the latest CMS rule changes are vast, presenting both…
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Introduction to social risk: What healthcare leaders need to understand
‘Social determinants of health’ has been a common phrase for decades now, but the term social risk is much less popularized. So, what does it mean and is it all that different from SDOH? Most importantly, what should healthcare leaders understand about social risk? Read on to find out. What is social risk? Social risk describes…
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AI is your new crystal ball: How predictive analytics can reduce denials
The idea of having a crystal ball to better understand what claims will be denied is an awesome concept. But one we can’t rely on. Thankfully, we have predictive analytics to take the place of a crystal ball.
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3 ways to reduce friction in payer-provider relationships
The dynamic between healthcare providers and payers has historically been quite strained. Though both parties are interested in improving the health of their populations, their approaches to accomplishing that goal are often at odds. In this blog post, we discuss how value-based care arrangements are setting the stage for smoother payer-provider relationships—and three ways payers…
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