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Avalere Survey Finds Cancer Hospitals Are Participating in Exchange Plans
Avalere, partnering with the National Comprehensive Care Network, surveyed 20 cancer centers and found that 75% of respondents were covered by at least "some" of the exchange plans in their state.
Most specialized cancer hospitals say they participate in the narrow provider networks of some exchange health plans, but health insurers have not been shy keeping some cancer hospitals out, according to a new survey from consulting firm Avalere Health.
The Avalere analysis follows an Associated Press report last year which found that many of America's most prestigious cancer hospitals were getting excluded from health plans sold on the Affordable Care Act exchanges in 2014. Household names like MD Anderson Cancer Center in Houston and Memorial Sloan Kettering Cancer Center in New York City had in-network agreements with a handful of exchange plans, the AP reported.
But other plans excluded them, and they were considered out-of-network and thus more costly for patients. Insurers said they weren't able to negotiate acceptable rates with cancer hospitals and other specialty providers, such as children's hospitals, in some markets.
Read the complete article at Modern Healthcare: http://bit.ly/1IL8sI9
Health Care Utilization and Cost of Diagnostic Testing for Respiratory Infections
September 17th 2025Syndromic reverse transcriptase–polymerase chain reaction tests for respiratory infections were associated with lower health care resource utilization and costs, implicating potential for improved value in patient care.
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AI in Health Care: Balancing Governance, Innovation, and Trust
September 2nd 2025In this conversation with Reuben Daniel, associate vice president of artificial intelligence at UPMC Health Plan, we dive into how UPMC Health Plan builds trust with providers and members, discuss challenges of scaling AI effectively, and hear about concrete examples of AI's positive impact.
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Infertility Coverage Boosts ART Use and Pregnancy Success: Richard A. Brook, MS, MBA
August 26th 2025In this episode, Richard A. Brook, MS, MBA, discusses his study showing that infertility treatment coverage increases assisted reproductive technology (ART) use and improves pregnancy outcomes.
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