HHS and CMS are creating the Healthcare Advisory Committee, a group of experts tasked with providing strategic recommendations directly to HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz.
The goal: improve how care is financed and delivered across Medicare, Medicaid, CHIP, and the Health Insurance Marketplace, while reducing red tape and putting patients first.
The Centers for Medicare & Medicaid Services’ (CMS) WISeR model (originally designed to streamline utilization management and prior authorization processes) is facing renewed attention from lawmakers. A bipartisan congressional letter sent to CMS questions the agency’s legal authority to apply the model to traditional Medicare and warns of potential impacts on beneficiary access, provider operations, and program compliance. As the healthcare industry awaits CMS’ response, payer and provider organizations should prepare for possible policy adjustments that could affect authorization workflows, clinical operations, and financial performance.
The U.S. Department of Health and Human Services (HHS) has finalized pivotal regulations designed to streamline e-prescribing and prior authorization processes. These new rules aim to enhance interoperability, reduce administrative burdens on healthcare providers, and improve patient care outcomes. As the healthcare landscape shifts towards value-based care, it is essential for decision-makers in healthcare organizations to align their systems with these changes to ensure compliance and optimize operational efficiency.
White House & CMS partner with 60+ healthcare and tech leaders to launch a patient‑centric digital health ecosystem with interoperability at its core.
The Trump Administration’s America’s AI Action Plan outlines a strategic framework for integrating artificial intelligence into healthcare, addressing both the opportunities and challenges it presents. By fostering collaboration among stakeholders and establishing regulatory guidelines, the plan aims to enhance patient care, ensure compliance, and drive innovation. This Industry Watch Alert highlights the key implications of the AI Action Plan for healthcare payers and providers, emphasizing the need to align AI advancements with value-based care initiatives.
OpenAI launched a $50 million Community Fund on July 18, 2025, to support nonprofits applying AI in healthcare, education, and community development—emphasizing ethical oversight and community impact.
The Centers for Medicare & Medicaid Services (CMS) has unveiled a proposed physician payment rule aimed at significantly reducing wasteful spending while enhancing quality measures for Medicare beneficiaries. This initiative emphasizes improved chronic disease management and marks a pivotal shift towards value-based care in the healthcare landscape.
On July 1, the U.S. Senate passed a sweeping tax and spending bill with far-reaching consequences for the healthcare industry. With $930 billion in cuts targeting Medicaid and ACA programs, and 11.8 million coverage losses projected, payers and providers face potential disruptions to reimbursement, compliance, and value-based care operations.
In June 2025, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced a new industry-wide initiative to streamline prior authorization processes. Led by HHS Secretary Robert F. Kennedy, Jr. and CMS Administrator Dr. Mehmet Oz, the roundtable brought together executives from major payers to formalize a set of voluntary commitments aimed at improving access to care and reducing administrative burden.
The effort is intended to advance value-based care goals by promoting interoperability, increasing process transparency, and reducing avoidable delays that contribute to inefficiencies and unnecessary costs across the healthcare continuum.
On June 9, 2025, HHS removed all members of the CDC’s vaccine advisory committee (ACIP), citing the need to restore public trust and eliminate conflicts of interest. Learn what this change could mean for healthcare payers, providers, and immunization policy in the U.S.
