Moody’s Keeps Insurers On Negative Outlook
Credit agency Moody’s Ratings has affirmed the negative credit outlook for the health insurance industry. Moody’s says medical costs continue to rise and plans will have limited prospects for profitable growth. It expects plan redesigns, benefit cuts, and exits from low-performing markets to continue. Moody’s notes that cost inflation has impacted every business line and will continue through the coming months. It says reimbursement rates have generally lagged these inflation rates.
#healthplans #margins
Healthcare Entities Struggle With Interoperability Mandate
The Workgroup for Electronic Data Interchange (WEDI) says a share of payers and providers have yet to start working toward the application programming interface (API) requirements for the interoperability and prior authorization final rule. WEDI advises the Department of Health and Human Services (HHS) on health information technology. Payers and providers must complete API requirements by Jan. 1, 2027.
As of February, 10% of payers had not started work on the APIs, down from 33% in October. Sixteen percent of payers anticipate being over 75% done with the patient access API by the Jan. 1 deadline, slightly up from the October assessment. The biggest roadblocks were third parties struggling to connect systems, digitizing prior authorization protocols, and having enough funding.
#interoperability #priorauthorization #healthplans #providers
— Marc S. Ryan
