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Own or Rent a Provider Network? Why Strategic Control Matters for Payers
A provider network is an operational asset that can influence medical expense, market competitiveness, and member experience. That is why payers must always have real-time data on how their contracts…
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AI ROI and Provider Network Contracting: What Payers Should Measure
Artificial intelligence is rapidly moving from experimentation to enterprise investment across the health care industry. The next challenge for executives is proving that those investments are actually creating value. That…
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Most-Favored-Nation Drug Pricing: What Medicaid Payers Need to Know
Prescription drug costs remain one of the most difficult expenses for Medicaid payers to forecast and manage. As federal policymakers explore most-favored-nation drug pricing, health plan executives need to understand…
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Medical Loss Ratio Rebates: What $759 Million Means for Payers
Health insurers are expected to return approximately $759 million in medical loss ratio rebates to individuals and employers in 2026. For payers, the number represents more than a regulatory obligation.…
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Healthy Aging Month: Why Provider Network Contracting Matters for Payers
September is Healthy Aging Month, an annual observance that encourages adults age 45 and older to take a more active role in their physical, mental, social, and financial well-being. For…
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Modernizing Provider Network Contracting
PwC’s report, The Future of the Healthcare Payer, makes one thing clear: health care plans must deliver greater value with fewer resources and at an unprecedented pace. But legacy administrative…
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