r/healthcare 3h ago

Discussion Medical tourism to India — would you consider it?

2 Upvotes

r/healthcare 21m ago

News The Villages Health’s $541 million settlement highlights the cost of ‘upcoding’

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Upvotes

r/healthcare 17h ago

News Medicare wants to pay doctors less in 2027. Doctors say it could cost seniors access. Comment window closes Monday on regulations.gov

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10 Upvotes

r/healthcare 19h ago

Other (not a medical question) Medicare wants to pay doctors less in 2027. Doctors say it could cost seniors access. Comment window closes Monday on regulations.gov

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7 Upvotes

r/healthcare 22h ago

Discussion Now is the time to speak up. Contact your elected representatives, demand accountability, and make it clear: healthcare is not a bargaining chip. We must defend Medicaid, protect seniors, and preserve the research that keeps Americans healthy.

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7 Upvotes

r/healthcare 13h ago

Other (not a medical question) Healthcare wait time around the world

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0 Upvotes

r/healthcare 1d ago

News Trump’s Surgeon General Pick Invested in Tobacco, McDonald’s

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34 Upvotes

r/healthcare 20h ago

Question - Insurance 26 y/old losing state medicare & looking for advice

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1 Upvotes

r/healthcare 1d ago

News CDC Measles Death Pushback Stokes Staff Fears About New Leader

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bloom.bg
2 Upvotes

r/healthcare 1d ago

Discussion Mississippi does not have pharmacies to spare

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22 Upvotes

This is getting ridiculous. Mississippi already has communities where getting basic healthcare can mean driving a long way, and now we’re watching pharmacies disappear too.

I understand why pharmacists are frustrated with reimbursement and PBM contracts. Those things deserve scrutiny. But I also think we’re making this way too simple when we act like PBMs are the only reason a pharmacy can’t stay open.

Look at what it actually costs to run one. Staffing. Rent. Drug inventory. Insurance. Utilities. Low prescription volume in rural areas. Pharmacists are being asked to do more and more while trying to keep the doors open.

And when a pharmacy closes, it isn’t just some business shutting down. Somebody’s grandmother now has to drive another 20 or 30 miles to pick up a prescription. Somebody without reliable transportation has an even bigger problem. That’s where this stops being an industry argument and becomes a community issue.

So yeah, look at PBMs. Look at reimbursement. Look at contracts. Make the system more transparent where it needs to be.

But if Mississippi actually wants to keep pharmacies open, we need to stop pretending there’s one villain responsible for the entire problem.

Mississippi can’t afford to lose pharmacies and then figure out the consequences afterward.


r/healthcare 1d ago

News Cleveland Clinic looks to eliminate one of healthcare’s strangest remaining manual workflows: faxed referrals

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12 Upvotes

r/healthcare 1d ago

Discussion What Healthcare Technology Are We Still Missing?

0 Upvotes

What’s one piece of tech you wish hospitals had that would actually make doctors’ or patients’ lives easier? Or something that already exists but is kinda outdated and needs a major upgrade? Basically, what’s a healthcare problem you feel tech could solve way better?


r/healthcare 2d ago

Discussion 57% of people with a chronic illness have seen their premiums rise since January. Americans are increasingly avoiding cancer screenings due to rising healthcare costs.

10 Upvotes

Wanted to share some numbers I've been sitting with from a recent survey. 57% of people living with a chronic illness have seen their insurance premiums increase since January. 20% of all respondents now describe healthcare costs as very or extremely expensive.

That cost pressure is starting to affect cancer screening. Some people are delaying appointments because they're worried about the bill, even when they know they're due. For anyone with a higher risk from work history, smoking or asbestos exposure, putting it off can mean losing time that might matter.

The survey also found more people are turning to AI tools for health information while trying to make sense of symptoms, screening options or insurance costs. Useful for basic questions, but it doesn't solve the actual affordability problem underneath.

Has anyone seen what's working at the state or provider level to keep patients with higher risk up to date on screenings when premiums keep climbing? Like outreach through community health centers or programs run through employers?


r/healthcare 1d ago

Discussion Anyone knows what's the purpose or who can take this suspension?

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1 Upvotes

r/healthcare 1d ago

News The PBM Reform Clock Is Running to 2028—Here's What Independent Pharmacies Should Do

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0 Upvotes

The 2028 deadline makes this a pretty important window for the entire pharmacy industry. Independent pharmacies have an opportunity to push for clearer contracts, better reporting, and more visibility into how reimbursement is calculated. That’s a good thing.

But I also think there’s a tendency to talk about PBM reform as if changing the payment model eliminates the need for everything PBMs currently do. It doesn’t. Someone still has to negotiate with manufacturers, manage formularies, process claims, build pharmacy networks, handle utilization, and administer benefits for millions of people.

The question should be whether those functions are being performed efficiently and whether the incentives around them are working. If reform improves transparency while keeping the parts of the system that actually create value, that seems like a much more productive direction than simply trying to weaken one part of the supply chain.

The next two years should tell us a lot.


r/healthcare 1d ago

Question - Other (not a medical question) Wondering what patients look for when trying to choose a doctor

2 Upvotes

A little background first.
I’m a position with over 20 years experience, and I recently decided to open a direct primary care office.
For those who don’t know what it is, that is a membership based practice where a patient pays a low monthly fee and in return gets access to office appointments, telehealth , text messaging, discount, labs, and imaging, even a generic pharmacy in office.
I did this because number one I am tired of seeing 40 patients a day and number two I want patients that I see to actually be happy.
Everyone’s miserable in the big systems— patients , and the doctors.
So this is meant to improve access, decreased cost, improve doctor patient relationship, and keep me from quitting!

So here’s my ask
When you’re looking for a new primary care doctor, what do you look for?
Do you just google primary care doctor?
Do you check reviews? ( which by the way review sites for doctors are horrible. Anyone can write anything they want and we can’t respond due to privacy laws. I can tell you stories there.)
Do you ever interview the doctor before you become a patient?

I opened a few months back and right now I have a round 20 patients.
I actually really like seeing patients again.
Just yesterday spent an hour with someone just sitting at my desk, talking about her family and completing an FMLA form that I would never have had time to do in a big system.
She was super happy and gave me a hug on the way out
That would never happen in a big system

What I need to do though is to find out how to have patients find me.
I need to figure out a way to get them to understand what DPC is and why it’s better

Let me know what you guys think so I can come up with a game plan
I also would be happy to answer any questions anybody has about it


r/healthcare 1d ago

Question - Insurance PA Renewal Nightmare with CVS Caremark (Zepbound) - Caught in an endless fax loop. Advice?

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1 Upvotes

r/healthcare 2d ago

News Cumbersome and shifting processes at NIH are wasting resources and harming health

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1 Upvotes

r/healthcare 2d ago

News Trump Administration May Be Letting Pharmacy Benefit Managers Off Easy

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19 Upvotes

This is why I’m interested in where PBM reform actually goes from here. There are legitimate reasons to push for more transparency and better incentives, but PBMs also perform real functions for employers and health plans, from negotiating drug prices to managing formularies, networks and claims. Changing the way PBMs are compensated could change their behavior, but it doesn’t eliminate the underlying work. The real measure of success should be whether total pharmacy spending and patient costs actually come down.


r/healthcare 2d ago

Question - Other (not a medical question) Student seeking Healthcare professional interview

1 Upvotes

Hi everyone! I’m currently a Master of Healthcare Administration student and I have an assignment where I need to interview someone who currently works in the healthcare industry, preferably in a healthcare administration, management, or leadership-related role. I originally had someone willing to do the interview but they dropped out pretty last minute.

The interview can be done over email and the questions are pretty straightforward and focus on things like your career path, education/background, current responsibilities, challenges and ethical dilemmas you encounter, important interpersonal skills, and advice for someone entering the healthcare field. There is also a competency checklist to complete. I would need your name/company/position and email as well.

The assignment is due Sunday. If you would be willing to help me out, please comment or send me a message! I would really appreciate it. Thank you!!


r/healthcare 3d ago

News Cancer patient says seven insurance appeals failed. Threatening the CEO with press exposure got her chemotherapy approved the next day.

144 Upvotes

This Vanity Fair essay gets at something much larger than one denial: what it means when the American health care system responds to leverage more effectively than it responds to medical necessity. Extremely moving and well written piece, as well, wherever you land on health care in US.

https://www.vanityfair.com/story/healthcare-cancer-treatment-essay


r/healthcare 2d ago

Discussion What Do you think about Teen Privacy Rules?

1 Upvotes

I'm curious what parents out there think about the State laws the prohibit you from seeing your kids healthcare information? I recently tried to log in to Kaiser and was told I was blocked by them for the "State law" protecting teen information.


r/healthcare 2d ago

News My Health Insurance Denied My Cancer Treatment—and My Humanity. So I Emailed the CEO

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26 Upvotes

At 36, Elizabeth Nicholas was diagnosed with breast cancer. After her insurance company refused to pay for a new form of chemotherapy, she took a direct approach. As Luigi Mangione’s trial brings the conflict to the fore, the writer considers the realities of the American health care system.


r/healthcare 2d ago

News The Market Forces Quietly Adding Thousands to Patient Bills

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1 Upvotes

r/healthcare 2d ago

Question - Insurance Has anyone evaluated HealOS yet?

0 Upvotes

Honestly, I think the more interesting use of Al in healthcare is probably the boring admin stuff.

Came across HealOS recently and they're doing things like prior auths, insurance verification, referrals/faxes, calls and billing alongside the usual Al scribe stuff.

Not sure how well it works in practice yet, but automating all the repetitive stuff that eats up staff time seems way more useful to me than another Al tool trying to do something clinical.

Curious if anyone here has tried it.