Consumer Driven Health Care

CMS fact sheet lays details for Medicare beneficiaries, as well as health care professionals.

As the year progresses, expect an increasing number of employers and benefits consultants to build value-based networks designed to improve health outcomes while reducing costs - and alternative care delivery sites will expand.

Insure.com surveyed more than 1,500 consumers about their health insurance, asking them to grade their providers on customer satisfaction, ease of service and policy offerings.

Starting in 2026, a proposed CMS rule would require plans to respond to a standard request within seven days, typically, instead of the current 14, and within 72 hours for urgent requests.

Benefits advisors and brokers need to understand price transparency from the participant and provider perspectives, the compliance mandates new federal regulations aim to achieve, and most importantly, what strategies benefits professionals can take to optimize their role and value.

Eli Lilly's announcement that it is capping the cost of insulin at $35 a month also casts light on pharmacy benefit managers at a time when Congress has shifted its focus on them.