Discussions with industry experts from across the ecosystem.
There's an acute need for new approaches to primary care in Medicaid, and a bill before Congress would extend additional flexibilities to state Medicaid agencies interested in exploring DPC as a potential solution.
Dec 19, 2025
Every payer is trying to manage ABA spending with rate cuts and UM. But what if the answer is an entirely different clinical model?
Creative supplemental benefit design, regulations requiring plans to show their work, and major themes going into 2026 across MA and SNP plans.
Dec 10, 2025
Nothing in specialty pharmacy is ever simple, but House Rx sees an opportunity for independent doctors to operate speciality pharmacies in their clinics to make things easier on the patients and add a line of business that helps them stay independent.
AI optimism, navigating internal tensions between innovations in the payer and provider businesses, and a framework for deploying AI across large organizations
NEMT is an obvious solution to a real problem, but it's also suffered from outsized levels of Waste, Fraud, and Abuse. Buck talks us through the balancing program integrity and convenience while opening up a new market for the ride share platform.
Dec 2, 2025
How payers are navigating pricing, growth, profitability, risk adjustment, and geography in the ACA marketplaces.
Nov 25, 2025
Value-based care, tech-enabled clinics, and some thoughts for states on how to make the most of their Rural Health Transformation Program budgets.
Nov 21, 2025
Prioritizing high value care, getting to yes, and when gold carding makes sense.
Nov 20, 2025
The new model has everything: it's mandatory, has upside and downside risk, and is focused on heart failure and low back pain. But is the juice worth the squeeze?
Discussing Priva's Q3 earnings, the Evolent ACO acquisition, and Privia's solid VBC performance
Nov 14, 2025
The complicated formula that CMS uses to compensate physicians got its annual update, including a raise for the first time in six years although not everyone is celebrating.
Nov 13, 2025
Big changes in Medicare physician payment, drug and skin substitute pricing, and other insights from the 2,300-page Medicare Physician Fee Schedule, explained by regulatory experts from Manatt Health.
Nov 12, 2025
Provider taxes and state directed payments will pull over $40 billion a year out of Medicaid spending once they're fully implemented which will send ripples through the health care economy.
Nov 7, 2025
Turmoil in the marketplaces, silver loading, and how insurance companies stack the shelves around open enrollment
Nov 6, 2025
What went wrong and what 2026 is looking like for the ACA individual market.
Nov 3, 2025
Untapped supply from NPs and ideas on how to unlock it
Oct 28, 2025
History doesn't always repeat, but it rhymes.
Oct 23, 2025
A discussion with the Acute Condition author and American Economic Liberties Project Senior Fellow on the alternatives to the increasingly corporate practice of medicine
Oct 21, 2025
The challenges and opportunities of Medicaid Managed Care for children, build versus buy decisions, and the opportunity for generational returns by investing in children’s health.
Oct 20, 2025
A discussion on the economics of third-party administration, opportunities to actually control costs in health care, and how simplicity can be a plan's saving grace.
Sep 30, 2025
A discussion with Mike Suiters on Positive Development's pioneering of developmental therapy and why Autism Spectrum Disorder therapy has gotten so expensive
Sep 23, 2025
