Marty Heath, MBA, FACHE

There is a technology gap in the specialty insurance industry. Read this great article from my MarshBerry colleague Tobias Milchereit to learn how firms can use emerging tech as a competitive differentiator. https://lnkd.in/ggdUFGyS

1

CMS just released three key figures that tell a story about the #Medicare #PartD market in CY2026. Read more:⬇️ #healthinsurance #fmo #insurancemarketing

🏥 𝐇𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞 𝐓𝐞𝐚𝐦𝐬 – 𝐀𝐬𝐤 𝐘𝐨𝐮𝐫 𝐃𝐚𝐭𝐚 𝐀𝐧𝐲𝐭𝐡𝐢𝐧𝐠 Still waiting days for patient outcomes, resource utilization, or claim approval reports? You don’t have to. With EzInsights AI, just type your question in plain English like: 👉 “What’s the average patient wait time across departments?” 👉 “How many claims were denied this month by insurance provider?” 👉 “Which procedures have the highest revenue contribution?” 𝐘𝐨𝐮’𝐥𝐥 𝐢𝐧𝐬𝐭𝐚𝐧𝐭𝐥𝐲 𝐠𝐞𝐭: ✅ Auto-generated SQL queries ✅ Interactive dashboards ✅ Patient + operations + claims + revenue insights ✅ ZERO dependency on IT or analysts From raw healthcare data to actionable insights – in seconds. 📊 Faster reporting. Smarter care delivery. Better outcomes. Healthcare is critical. Your insights shouldn’t wait. 👉 See More: https://lnkd.in/dJRjVQ6C 👉 Start Free Trial: https://lnkd.in/de5sYKaf #HealthTech #HealthcareAnalytics #EzInsightsAI #PatientCare #ClaimsAutomation #HospitalOps #NoCodeBI #AskYourData #AIforHealthcare #DataSimplified

7

McKnight’s recently shared new survey findings showing how providers are approaching 2026 with more cautious optimism. There’s a strong focus on operational efficiency, clear financial priorities, and more alignment between business decisions and care delivery. That shift lines up with what we’re seeing in our work with companies that serve the senior care sector. Leaders are asking thoughtful questions about growth, capital, and execution, and setting clearer expectations across their commercial teams. This is a useful snapshot of where the industry mindset is heading and worth a read. You can read the full article here: https://lnkd.in/esTHnq24

3

MCRA Members, Avalere Health and DRG CLAIMS MANAGEMENT were recently published in Managed Healthcare Executive (MHE) 🎉 They explored how Medicare Advantage plans must take a coordinated, organization-wide approach ahead of CMS' new risk adjustment data validation (RADV) strategy. 👉 https://loom.ly/V8kdF-4 #CMS #RADV #RiskAdjustmentDataValidation #MHE #ManagedHealthcare Executive #MedicareAdvantage #HealthPlan

18

Our VP and Associate Director of Med Solutions, Jeff Sullivan, is featured in the March - April 2026 issue of Aspire Magazine! In the article, Jeff shares insights on the value of cross-selling and how agents can better support clients navigating today’s evolving Medicare landscape. Read the full feature on page 40: https://lnkd.in/gqnYK7gE

40

In the U.S., more than 80% of insurance executives report that it takes over 30 days to close a single claim, a delay that can put serious strain on the revenue cycle. See how Medical Associates of Northwest Arkansas (MANA) took on this challenge using LGI RPA automations that mimic routine human actions: 👉 https://hubs.la/Q03zh6LH0 #HealthcareRPA #RevenueCycle #ClaimsProcessing

5

Prescription drug spending isn’t just a number on a chart—it’s a growing strain on families, employers, and the broader healthcare system. Adam Fein's analysis shows what many of us see daily: costs are accelerating, share of payment is shifting, and vertically integrated players are positioned to prosper. The real question is whether innovation and accountability will keep pace or whether we’ll continue to pay more for less. For employers especially, this is a call to rethink how benefits are structured and how dollars are spent. Transparency, alignment, and new models of care aren’t optional anymore—they’re urgent and significant priorities. (Did I mention that Revive has two in-house pharmacies? If that's of potential interest for your benefits planning, let's talk...)

6

The long-term care market has crossed USD 1.11 trillion, and the pressure on care teams continues to grow. Understanding where the industry is headed is critical for planning what comes next. Explore the key statistics and trends in our latest blog. Read more: https://lnkd.in/eXdSeNXD

6

Q2 doesn't get much attention in the Medicare insurance world. AEP gets the headlines, OEP gets the urgency, and Q2 quietly becomes the quarter that organizations treat as a break. Graylon D. Perkins, Qualfon's VP of Performance Marketing, would push back on that. In his latest piece, Graylon shares the Q2 checklist he encourages FMO, IMO, and agent partners to follow, covering CMS compliance monitoring, product forecasting, AEP marketing playbook refreshes, data hygiene, agent development, and budget alignment. The organizations that run a smooth AEP aren't the ones making last-minute adjustments in September. They're the ones who did the work in April. Read Graylon's full Q2 playbook: https://hubs.la/Q0485JDG0 #MedicareInsurance #InsuranceMarketing #AEP #PerformanceMarketing #LeadGeneration

27

4 Comments

Did you know? Starting October 1, 2025, Cigna will begin downcoding certain high-level E/M codes — meaning many Texas practices could see reduced reimbursements unless documentation meets their algorithm-driven standards. Here’s the kicker: Other payers like UHC, Aetna, and Humana have already started similar practices quietly, leaving providers scrambling. Appeals succeed 80–90% of the time, but at the cost of delayed revenue and added administrative burden. At Innosphere, we stand with Texas physicians and billing teams who are doing everything right but still feeling the squeeze. 🔗 Read the full TMA coverage here: https://lnkd.in/e7jVcvR7 It’s time for payers to be transparent — and for the healthcare community to speak up. Because fair reimbursement isn’t just about numbers, it’s about keeping practices sustainable and patient care uncompromised. #TexasHealthcare #RCM #MedicalBilling #PhysicianAdvocacy #InnosphereSupportsYou

1

This partnership with Nationwide and LIBRA Insurance Partners is a powerful step forward for Kadance and the members we serve. Kadance is bringing access to precision medicine, advanced diagnostic testing, and expert support to more people through a life insurance benefit that prioritizes proactive health. At Kadance, we’re proud to lead this shift—delivering personalized, impactful solutions that help members take control of their health with clarity and confidence.  #PrecisionMedicine #Genomics #InsuranceInnovation

9

🚨 Price negotiations are coming: https://lnkd.in/eirqGXdt 📝 CMS has placed semaglutide drugs on its 2025 list. 📉 This could mean significantly reduced costs for Medicare patients by 2027. 🔑 Plan your benefits strategy accordingly. 👀 Watch the full video here: https://lnkd.in/ejEde_dN #NFP #Insurance #EmployeeBenefits #HealthcareStrategy #GLP1Drugs #EmployeeWellness #PharmacyBenefits

10

𝗛𝘂𝗺𝗮𝘁𝗮 𝘀𝗮𝘁 𝗱𝗼𝘄𝗻 𝘄𝗶𝘁𝗵 Healthcare Financial Management Association (HFMA) 𝘁𝗼 𝗱𝗶𝘀𝗰𝘂𝘀𝘀 𝘄𝗵𝗮𝘁 𝗪𝗜𝗦𝗲𝗥’𝘀 𝗝𝗮𝗻𝘂𝗮𝗿𝘆 𝗹𝗮𝘂𝗻𝗰𝗵 𝗺𝗲𝗮𝗻𝘀 𝗳𝗼𝗿 𝗽𝗿𝗼𝘃𝗶𝗱𝗲𝗿𝘀— 𝗮𝗻𝗱 𝗵𝗼𝘄 𝗼𝗿𝗴𝗮𝗻𝗶𝘇𝗮𝘁𝗶𝗼𝗻𝘀 𝗰𝗮𝗻 𝗽𝗿𝗲𝗽𝗮𝗿𝗲 𝗳𝗼𝗿 𝗮 𝗺𝗼𝗱𝗲𝗹 𝘁𝗵𝗮𝘁 𝗶𝗻𝘁𝗿𝗼𝗱𝘂𝗰𝗲𝘀 𝗳𝗮𝘀𝘁𝗲𝗿 𝗿𝗲𝘃𝗶𝗲𝘄𝘀, 𝘁𝗶𝗴𝗵𝘁𝗲𝗿 𝗱𝗼𝗰𝘂𝗺𝗲𝗻𝘁𝗮𝘁𝗶𝗼𝗻 𝗲𝘅𝗽𝗲𝗰𝘁𝗮𝘁𝗶𝗼𝗻𝘀, 𝗮𝗻𝗱 𝗮 𝗻𝗲𝘄 𝗼𝗽𝗲𝗿𝗮𝘁𝗶𝗼𝗻𝗮𝗹 𝗿𝗵𝘆𝘁𝗵𝗺 𝗳𝗼𝗿 𝘁𝗿𝗮𝗱𝗶𝘁𝗶𝗼𝗻𝗮𝗹 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲. In the interview, CEO Jeremy Friese, MD offers a candid look at: • Why WISeR is so narrowly targeted — and why CMS selected specific codes and services • How Humata is supporting CMS as the review partner for Oklahoma • How our technology assists reviewers by identifying straightforward cases — and elevating complex cases for clinical assessment • What providers can expect in terms of turnaround times, oversight, and future “gold card” opportunities • Why this model is fundamentally different from traditional prior authorization experiences in commercial and MA plans The conversation addresses head-on the concerns providers have raised, from payment structures to AI transparency to the operational realities of launching a new Medicare review model. 👉 Read the full HFMA article: https://lnkd.in/eX6_QM2R

16