Webinar - Stop Leaving VBC Revenue on the Table: Fix Your Identity Data Presented by Verato

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Featured Story   Will CMS’ Last-Minute Medicaid Work Requirement Changes Cause More Harm? The skinny A new interim final rule affecting Medicaid work requirements could leave states scrambling and cause many to lose coverage. The interim final rule The One Big Beautiful Bill Act of 2025 enacted significant changes to the Medicaid program, including work requirements. These requirements mandate that Medicaid members ages 19 to 64 covered through the Affordable Care Act Medicaid expansion prove 80 hours per month of employment, education or volunteering. These changes are set to take effect in January 2027. But on Monday, the Centers for Medicare and Medicaid Services took it a step further with an interim final rule to the work requirements. One major change is adding conditions to the medical frailty exemption from the work requirements. Medical frailty includes blindness or disability; substance use disorder; disabling mental disorder, physical, intellectual, or developmental disability that significantly impairs a person’s ability to perform one or more activities of daily living; and serious or complex medical condition. The new rule now requires that medical frailty be limited to situations in which a person’s condition impairs their ability to meet the work requirement. In other words, it’s no longer sufficient to merely have one of these conditions to qualify for an exemption. They now have to prove to state authorities that their condition is serious enough that they can’t fulfill the requirements. This now means that some people who previously fit the medical frailty exemption may no longer qualify, according to a recent analysis from the Center on Budget and Policy Priorities. For example, people with a serious medical condition, like cancer, may have received an exemption. But if the interim final rule is adopted, will states have to adjudicate who is too sick to work those hours? The complicating factor is that some cancer patients may be able to work 80 hours in some months, but if they are receiving chemotherapy, they may be too fatigued to work 80 hours in another month. Soundbite “It's not going to be enough, for example, for somebody to have cancer,” said Allison Orris, senior fellow and the director of Medicaid policy at CBPP. “They are going to have to raise their hand, or the state will have to determine that not only do they have a cancer diagnosis, but that their cancer diagnosis is essentially serious enough that they have a significant inability to comply. That two-step process is, I think, different than what many states had been assuming as they were building their systems to implement this law, and will add a lot of burden both for individuals and for states in their implementation process.” — By Marissa Plescia Sponsored   Webinar - Stop Leaving VBC Revenue on the Table: Fix Your Identity Data Presented by Verato Value-based care (VBC) promises better patient outcomes and sustainable reimbursement—but only if you can actually connect the dots between your patients, providers, and encounters. True interoperability requires extending identity resolution far beyond your internal systems. Join us on June 17th at 1p ET where we’ll dive into how a unified identity strategy can secure your revenue and scale your VBC programs. Top Stories   The 3 Biggest Roadblocks to Egg Freezing — and How Providers Are Working to Remove Them Cost Financial concerns are the primary reason many people delay family building, pointed out Raghav Mishra, vice president of product at Sunfish, during a panel the fertility startup hosted last week in New York City. The average cost of egg freezing in the U.S. is about $15,000. Mishra acknowledged that employer fertility benefits — such as those offered through companies like Progyny and Carrot Fertility — can help but noted that patients often still face significant out-of-pocket costs under these models. As a direct-to-consumer platform, Sunfish's current focus is on supporting patients regardless of whether they have employer-sponsored fertility benefits, Mishra said, noting that the company connects patients with financing options, grants and discounts that can offset some of the costs. Uncertainty One of the biggest challenges with egg freezing is that fertility is highly individualized, making outcomes difficult for clinicians to predict, noted Dr. Chelsea Canon, a reproductive endocrinologist at Reproductive Medicine Associates of New York. Even among women of the same age with similar lifestyles and health histories, egg freezing outcomes can vary significantly, she said. This is why Sunfish designed its egg freezing program to reduce some of the financial risk associated with unpredictable outcomes, Mishra said. If a patient's egg retrieval yields fewer eggs than projected by Sunfish's clinical team, the startup covers the cost of a second retrieval cycle. Timing Issues Another fertility expert — Tiffany Hallgren Crook, CEO of TLC Infertility & Donor Services — pointed out that there is no perfect time to freeze eggs. Still, many people wait for ideal circumstances that never arrive. She noted that earlier egg freezing generally leads to better outcomes because egg quality and quantity decline with age. Also, earlier is better because unexpected medical events can occur. Hallgren shared that she was diagnosed with an aggressive form of breast cancer at age 28 and needed to begin chemotherapy within days. Because she had already frozen her eggs, she was able to quickly move forward with this treatment knowing she had preserved an option for future family building. — By Katie Adams It's Time for Technology to Lift Maternal Care A worsening trajectory The underlying dynamics of maternal care are in a critical state. Labor and delivery units are closing across the country, severely diminishing access to care. Experienced nurses are being replaced by less tenured staff and attrition among veteran providers is on the rise. Patients are older and present with more comorbidities. Longstanding disparities continue to put women of color at significantly higher risk. These pressures are converging in real time at the bedside — and many of the tools meant to support care have not kept pace. Can AI combat bias? There is much concern about the ‘black box’ of AI persisting bias, especially that shown towards women of color in peripartum care. But AI models born of intentional supervised learning may in fact offer an opportunity to combat that bias by specifically omitting any racial or ethnic factors in training. Well developed and carefully validated systems, trained on intentionally curated data, can help shift the focus toward objective clinical patterns, supporting earlier and more uniform recognition of risk across diverse patient populations. Human decision-making will always be influenced by experience, fatigue, or implicit bias, whereas these models apply consistent criteria across patients. Helping to recognize risk Improving maternal safety will not come from adding more data or more devices. It will come from building systems that help clinicians recognize risk earlier and communicate and act with confidence in the moment. Technology has an urgent role to play in improving maternal care, but it must be engineered to provide clarity, not just more or different data and it must be flexible and easy to deploy, even in the most bare bones environment. — By MedCity Influencer Matthew Sappern The Smart Way to Build the Future of Fertility Benefits Better understanding is needed Employers are continuing to expand fertility benefits, but many still don’t have a clear understanding of what they’re actually paying for. With the White House encouraging businesses to expand fertility coverage, employers have an opportunity to lead – not by simply increasing spend, but by demanding better outcomes. Three emerging themes The challenge isn’t just access to fertility benefits, it’s how those benefits are structured and delivered. Across the industry, three themes are emerging that can help employers better align cost, quality and experience. Don’t just look at the price tag; compare the outcomes. High-quality medical care saves money in the long run and leads to better results. Fertility care works best when clinicians, labs, and pharmacies operate in a more coordinated way. Collaboration enables faster, better-informed decisions, reduces referrals, and shortens the time to pregnancy. IVF medications can be one of the most opaque and wasteful parts of the process. More transparent approaches, including upfront drug pricing, same-day delivery, and as-needed dispensing, reduces waste and helps employees with financial planning. No longer a niche offering As employers continue to expand fertility benefits, the focus is shifting from access alone to value, how care is delivered, what outcomes are achieved, and how employees experience the process. Fertility is no longer a niche offering, expectations around quality, transparency, and results will continue to rise. — By MedCity Influencer David Stern Video   Video: How to Think About AI in Prior Authorizations How should we think about leveraging AI in managing prior authorizations? Matt Parker, chief product officer of Cohere Health, explains three things to watch in this video.

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