Payer Systems

How Massachusetts Can Fix Its Primary Care Shortage
Management & Administration How Massachusetts Can Fix Its Primary Care Shortage

Backed by world-famous hospitals yet burdened by long waits for basic checkups, Massachusetts has been confronting an uncomfortable paradox in which a patient in Worcester or the Berkshires can be told to expect a primary care appointment in 18 to 24 months while the state proudly touts biomedical

GLP-1 Telehealth in 2026: When the App Becomes the Clinic
Management & Administration GLP-1 Telehealth in 2026: When the App Becomes the Clinic

Smartphone taps replaced waiting rooms as GLP-1 care compressed from weeks into days for patients who once navigated referrals, voicemails, and opaque coverage rules that stalled momentum at the exact moment motivation peaked. What used to hinge on faxed records and office schedules now flows

Solace Health Extends Care Navigation to Commercial Plans
Management & Administration Solace Health Extends Care Navigation to Commercial Plans

Lead Phone trees multiplied, codes blurred into alphabet soup, and a single referral ricocheted between clinics and carriers while deadlines crept closer and bills kept arriving, yet the stakes stayed clinical, financial, and deeply personal all at once. In that thicket, a simple proposition stood

Ohio Reviews CareSource Medicaid Clawbacks Amid Access Fears
Management & Administration Ohio Reviews CareSource Medicaid Clawbacks Amid Access Fears

An unexpected wave of Medicaid “clawback” notices rippled through Ohio’s behavioral health community, upending routine billing cycles and forcing small practices to weigh legal action against the risk of shuttering vital services for vulnerable patients who already face long waits for care. In

Medicare AI Pilot Triggers Major Patient Care Delays
Management & Administration Medicare AI Pilot Triggers Major Patient Care Delays

The federal government's attempt to modernize the Medicare framework through sophisticated artificial intelligence has sparked a fierce national debate regarding the precarious balance between administrative efficiency and the fundamental right of patients to receive timely medical care. At the

What Does CJR-X Mean for the Future of Joint Replacement?
Management & Administration What Does CJR-X Mean for the Future of Joint Replacement?

The orthopedic surgical landscape is currently undergoing a fundamental transformation as Medicare moves decisively away from traditional reimbursement structures that have historically rewarded quantity over quality. For several decades, the federal government has reimbursed healthcare providers

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