The Hertel Report

Arizona Vaccination Rates Lag as U.S. Reports First Measles Deaths of 2026

Arizona News

Arizona News

In Memoriam: Joseph 'Joe' Peter Anderson, AHCCCS Pioneer

On Saturday, August 29th, friends, family and colleagues will remember Joseph “Joe” Peter Anderson, an Arizona healthcare leader who helped rebuild and stabilize the state’s fledgling Medicaid program during the 1980s. Anderson died Aug. 4 at age 76. The Arizona native was born in Prescott and died at Santa Rosa Memorial...

White Papers, E books, Reports and more

Rand Report Explores Preparation and Biosecurity in Face of Outbreak

A new report warns that national defenses against a biological attack are at a natural disadvantage, as the country would need to be actively prepared to confront any number of biological agents, but even then a novel pathogen could easily evade preparations. AI-enabled biotechnology could reduce some of the challenges to defending...

National News

Healthcare Private Equity Activity Lagging

Healthcare is business, meaning that its susceptible to all the dangers of typical market activity, especially from the aggressive merger-acquisition strategy of private equity firms. But as the infrastructure of medical care delivery constricts, the market has slowed its spread through higher interest rates as utilization rates weigh on...

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Milliman Tells Employee Sponsored Health Plans - Audit Your PBM

In this benefits brief, Milliman recommends routine audits of pharmacy benefit managers (PBMs), as prescription drugs have become one of the fastest-growing, most expensive, and least transparent components of employer health plans. The firm identifies three primary benefits. Audits help plan sponsors fulfill fiduciary and oversight...

National News

Trump Administration Expands Autism Initiatives Amid Vaccine Claims and Funding Cuts

Earlier this month, President Donald Trump signed an executive order instructing the Department of Health and Human Services to pare down immunizations and split up the MMR vaccine in an effort that falsely tied the childhood vaccine schedule to rising levels of autism diagnoses in American children. Now, the Trump administration is...

Arizona News

Commure Attracts Scrutiny Over Billing Practices & Referral Fees

A much-touted venture-backed startup that promised to revolutionize the delivery of healthcare through its AI software platform is under scrutiny following an investigation into its marketing practices, which may violate federal anti-kickback laws for Medicare and Medicaid. Commure is a company that may be familiar to those in the...

Arizona News

OIG Finds Gaps in AHCCCS Oversight of Mental Health Parity

A new federal audit found AHCCCS failed to adequately ensure three Medicaid managed care organizations were analyzing whether prior authorization requirements for mental health and substance use disorder services complied with federal parity rules. The findings did not establish that the plans imposed more restrictive requirements on...

National News

ASPE Projects Provider Tax Cuts Will Lower Costs Outside Medicaid

The One Big Beautiful Bill Act of 2025 (OBBBA) funded most of its ambitious program through a series of Medicaid cuts, not only through work requirements but also through curbing state methods of provider compensation designed to boost the federal match while maintaining provider participation. The Assistant Secretary for Planning and...

National News

MedPAC: Value-Based Models Now Reach Most Medicare Beneficiaries

Last month, MedPAC published a slew of data, including an update on the commission's analysis of the growing role of value-based care in the lives of Medicare FFS beneficiaries. About 200,000 Arizona Medicare beneficiaries received care through an accountable care organization in 2024, according to the latest state-level enrollment data...

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Milliman Explains Comprehensive Care for Joint Replacement Expansion

In the 2027 Inpatient Prospective Payment System (IPPS) rule, the Centers for Medicare and Medicaid Services finalized a new payment model that its calling the Comprehensive Care for Joint Replacement Expansion (CJR-X), which resurrects a formerly sunset payment model for Medicare joint replacement reimbursement and expands it as a...

Arizona News

Banner Health Clinicians Vote on Forming Arizona’s First Physicians’ Union

Voting is underway among Banner Health doctors to determine if they will form Arizona's first physician's union at the state's largest private employer. Working with the Union for American Physicians and Dentists (UAPD), which has worked to form more than 30 bargaining units across 100 healthcare settings nationwide, Banner's doctors...

National News

CMS Expands Prior Authorization Transparency as Calls for a Ban Grow

As calls to end the practice of prior authorization mount, the Centers for Medicare and Medicaid Services (CMS) are scrambling to assuage public concerns by offering new guidance for plans to publicly report prior authorization data and accompanying requirements for posting the reporting. CMS posted the new guidance in compliance with...

Data Resources

Kaufman Hall: June National Hospital Flash Report

Hospital operating margins remained stable through June, but Kaufman Hall found growing financial pressure beneath the surface, particularly for smaller and rural facilities with limited cash reserves. Bad debt and charity care increased both in dollars and as a share of hospital revenue during the first half of 2026. Emergency...

National Reports & Surveys

Brookings Research: Options for Modernization of Traditional Medicare

With the Annual Enrollment Period for Medicare Advantage right around the corner, Brookings researchers argue that traditional Medicare’s 61-year-old benefit structure is increasingly uncompetitive with Medicare Advantage and leaves beneficiaries vulnerable to catastrophic healthcare expenses. Unlike Medicare Advantage, traditional...

Arizona Comings & Goings

Banner-University Medicine Names New COO

Banner – University Medicine has named Charles Socci, RN, MBA, chief operating officer for its Tucson operations, effective Sept. 14. Socci will oversee daily operations at Banner – University Medical Center Tucson and Banner – University Medical Center South, with responsibility for quality, patient safety, service, employee...

National News

CMMI May Test New Approaches to Medicare Advantage Stars and Risk Scores

The Center for Medicare and Medicaid Innovation (CMMI) was created by the Affordable Care Act of 2010 to creatively work through issues of healthcare quality and rising health costs through demonstrations of payment mechanisms that prioritize health outcomes, commonly referred to as "value-based care." The expectation has been that at...

Arizona News

Judge Strikes Down CMS Payment Restriction for Safety-Net Hospitals

Last month, a federal judge vacated a 2023 Medicare payment rule that limited payouts to disproportionate share hospitals (DSH) which could deliver a significant boost to embattled safety-net providers facing compounding market and regulatory stressors. The federal crackdown on Medicaid provider taxes and a sharp increase in...

National News

New CMS Policy Cuts Federal Funding for Gender-Affirming Treatment for Minors

The Trump administration's efforts to rescind federal support for transgender healthcare services continued this week as the Centers for Medicare and Medicaid Services (CMS) announced that Medicaid will stop paying for gender affirmative treatments for transgender minors. The policy is set to go into effect beginning October 13, with...

Arizona News

Arizona Small-Group Insurers Seek Double-Digit Premium Increases for 2027

Arizona health insurers are requesting double-digit premium increases for small-employer plans covering at least 83,404 people and policyholders in 2027, according to the most recent filings. The total reflects enrollment disclosed in Rate Review filings reviewed by The Hertel Report and excludes Cigna plans and a Blue Cross Blue...

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Policy Paper: Ban Prior Authorization

The former director of the Office of Policy Planning at the Federal Trade Commission under President Joe Biden is leading the charge for a ban on prior authorizations with a new policy paper. Hannah Garden-Monheit worked at the FTC on efforts to ban noncompete clauses in contracts and to investigate pharmacy benefits managers before...