Policy

Health care fraud, new payment models and AI are all in play in evolution of accountable care

RFK Jr. says California and Minnesota have to prove the legitimacy of claims before the money flows.

New survey data shows why real-time support — not personalization or speed — is what actually keeps members loyal to their health plan

A new KFF Health Tracking Poll finds most voters believe Medicare and Medicaid fraud comes from the billing side of care, doctors’ offices and hospital systems, rather than from the patients who receive it.

Perceptions, policies and prices all are factors in the future of direct primary care, advocates say

Access, AI and accountable care are part of now and the future, CMS leaders say.

Health policy veteran and "Zen Lobbyist" author Gary Jacobs argues that the payment system, not the insurers, is behind a second straight year of double-digit ACA premium increases, and that primary care-led risk is the only durable fix.

The top news stories in medicine this week.

Actions this week involve three major health care policy bills

Greater availability of the blockbuster drugs does not mean every older patient should get them.

The draft 2027 Medicare Physician Fee Schedule opens five questions about the AMA's control of CPT codes, from licensing costs to who decides what a code is worth.

Physician lawmakers support primary care, inflation-indexed payments and new POINTS system for quality reporting.

CMS wants to cut the conversion factor, rewrite the G2211 add-on into a percentage modifier, halve payment for same-day procedures and put an expiration date on traditional MIPS.

Accountable care wins, but physicians and policy experts warn cuts are baked in

Two physicians and two health system executives got candid with Chief Healthcare Executive about denials, administrative burden and what AI is actually delivering.

As patient demand outpaces staffed beds and workforce growth, early clinical guidance from nurses is emerging as a way to protect physicians, shorten wait times and stabilize access — especially in rural and safety-net communities.

Patient demand is high, but distinctions are fuzzy about compounded GLP-1s. Primary care physicians can help

CMS chief Dr. Oz touts ‘some of the most significant Medicare reforms in recent years’

For better health at a cheaper cost, the nation needs more investment, access and doctors in primary care.

The top news stories in medicine this week.

AMGA, lawmakers lead charge against beneficiary pay for chronic care management.

Insurers are seeking a median 14% increase for 2027, a jump that would leave typical marketplace premiums more than one-third higher in two years.

Answers on adapting to shifts in Medicare, with three strategies to implement right now.

New YouGov data rank what patients consider before agreeing to a treatment.

Lowering drug costs for older adults is a laudable goal, but don’t do it by blocking physician access to needed medicines.