Healthcare provider network and plan design

The provider network and plan design refers to the configuration of healthcare providers and the structure of health plans offered to patients. Effective network and plan designs are crucial for ensuring accessibility, affordability and quality of care for healthcare consumers. The elements directly affect cost management, quality of care and member satisfaction.

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News 04 Mar 2025
Commercial insurance coverage for GLP-1s still limited

Fewer insured people have coverage for GLP-1s, while more are beholden to prior authorization and step therapy before gaining access to the drugs. Continue Reading
By
- Sara Heath, Executive Editor
Feature 27 Feb 2025
How companies find solutions to employer GLP-1 coverage

Employer GLP-1 coverage has serious cost barriers, but some companies are turning to technology vendors to provide a comprehensive approach to access. Continue Reading
By
- Kelsey Waddill, Managing Editor and Multimedia Manager
- Sara Heath, Executive Editor

xtelligent Rev Cycle Management

How AdventHealth taps technology to get ahead of claim denials
A new AI-driven technology is helping AdventHealth prevent claim denials while the health system builds a more intelligent ...
House bill would lead to provider revenue problems: Analysis
An analysis estimates more than $770 billion in provider revenue losses and substantially higher uncompensated care costs over ...
Initial claim denial rates put revenue cycle in tough spot
New data shows an increase in initial claim denial rates, which are putting pressure on patient collections and the overall ...

xtelligent Virtual Healthcare

How telehealth is connecting the unhoused to care in SC
MUSC Health's hybrid CARES program expands access to unhoused individuals, leveraging telehealth and street medicine to reduce ...
Healthcare wearable intervention cuts alcohol use, boosts sleep
A digital health program that included self-monitoring via a mobile diary and healthcare wearables helped reduce alcohol intake ...
Home health agencies drop telehealth, citing applicability, costs
Home health agencies are discontinuing telehealth services, indicating uncertainty about telehealth's appropriateness in the home...

xtelligent Patient Engagement

Zocdoc unveils first-ever payer deal for appointment booking
Zocdoc's partnership with Blue Shield of California is intended to improve member experience by promoting better access and ...
Designing patient education in cancer care for health equity
Patient education in cancer care needs to be more inclusive to patients of all demographics to achieve health equity.
Non-English speakers face breast cancer treatment delays
Patients with limited English proficiency face breast cancer treatment delays of up to 11 days, but language services can ...

xtelligent Health IT and EHR

What are the top 8 healthcare data and coding standards?
Data standards are the secret sauce that allow information to flow from one provider to another and enable providers to bill for ...
How a FQHC balances innovations in health IT with budget
Mountain Laurel Medical Center operates with a limited budget, but the federally qualified health center still invests in ...
ASTP/ONC taps Thomas Keane for national coordinator role
Thomas Keane, M.D., M.B.A., brings prior ONC experience as he's slated to lead ASTP/ONC.

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