03 Mar Health Data News Roundup: AI Prior Authorization Threatens Care; Better Member Experiences; and MA Enrollment Down

Welcome to the Health Data Weekly News Roundup from IMAT Solutions. As the power of data continues to grow in the healthcare arena, today’s care organizations need to be on the forefront of all news and trends to help ensure that their data analytics efforts deliver accountable and informed care. Each week, we will provide you with the actionable news you need to meet these goals.

AI Prior Authorization Denials Threaten Patient Care
The 2024 American Medical Association prior authorization physician survey reveals that 61 percent of physicians are alarmed by the health insurance industry’s increasing reliance on unregulated artificial intelligence in prior authorization decisions.

What Does Member Experience Mean for Health Payers?
Keeping up with the demands of healthcare consumerism, member experience and satisfaction have become key for health payers, and can support their financial bottom lines, according to Health Payer Intelligence.

Seven Information Exchange Insights to Know for Payers
Data exchange options being promoted by TEFCA through QHINs have a variety of implications that payers need to fully understand before signing up, according to this recent Health Data Management article.

CMS Data: Medicare Advantage Enrollment Growth Hits Skids
According to CMS data, just over 34.4 million people were enrolled in Medicare Advantage (MA) plans as of Feb. 1, representing slim growth across the program’s annual enrollment period, as highlighted by Fierce Healthcare.

The Growing Impact of Medicare Advantage on Rural Hospitals Across America
A new American Hospital Association (AHA) report highlights how many Medicare Advantage plans’ practices exacerbate rural hospitals’ vulnerability and threaten health care access for rural communities.

Illinois, North Carolina Payers to Exit All Markets Except Medicare Advantage
Champaign, Ill.-based Health Alliance and Southern Pines, N.C.-based FirstCarolinaCare will no longer offer any insurance plans past 2025, with the exception of Medicare Advantage, according to Becker’s Payer Issues.

Humana’s CenterWell to Add 20+ Clinics in 2025
Humana plans to open between 20 and 30 primary care clinics in four new metro areas in 2025 through company’s CenterWell primary care brand, according to Becker’s Payer Issues.