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

Medicare Advantage enrollment slows, increasing 3.9%
Strong market headwinds dampened Medicare Advantage enrollment during the 2024 annual enrollment period but growth in MA and SNP ...
5 leading hospital chargemaster software products
Hospital chargemaster software from FinThrive, Health Catalyst, Optum and other vendors can streamline CDM maintenance while ...
Providers don't see better quality under value-based payments
Primary care providers do not see the benefits of value-based payments on quality of care at the organizational level as many ...

xtelligent Virtual Healthcare

How 3 health systems are using telemedicine for dementia care
Telemedicine for dementia care can help increase access, especially for rural and elderly patients, but it faces challenges such ...
Type of chronic condition may dictate telehealth use
Patients with certain chronic conditions, like COPD and cancer, are less likely to use telehealth than those with heart failure ...
Demographic disparities persist in video visit utilization
A UC Davis Health study found demographic characteristics are linked to video visit utilization, with older and Black patients ...

xtelligent Patient Engagement

Capturing social determinants of health data in rural health
Armed with a strong health IT system and dedicated nursing and social work team, Sparta Community Hospital acts on social ...
Leapfrog: Patient safety in maternity care slow to improve
Leapfrog Group data shows key areas for improvement, particularly with C-section rates, to boost patient safety in maternity care.
When are patients willing to wait to see their own PCP?
Patients are willing to wait longer to visit a primary care doctor for sensitive exams but are open to seeing the soonest ...

xtelligent Health IT and EHR

Attitudes toward AI in healthcare improve, but concerns remain
New survey results show that physicians are increasingly using AI for clinical documentation, but many indicate concerns about ...
The Sequoia Project launches pharmacy interoperability group
The Sequoia Project has launched a workgroup to drive pharmacy interoperability, welcoming 40 healthcare organizations as members...
Lawmakers reintroduce MATCH IT Act for patient matching
The bipartisan Match IT Act of 2025 aims to establish patient matching standards to enhance patient safety and reduce healthcare ...

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