The concurrent authorization process is plagued with challenges for both payers and providers. Inefficiencies like administrative burden, communication gaps, and inconsistent medical necessity determinations lead to increased costs and a poor member experience.
The concurrent authorization process is plagued with challenges for both payers and providers. Inefficiencies like administrative burden, communication gaps, and inconsistent medical necessity determinations lead to increased costs and a poor member experience.
CMS’s 2025–2030 updates to Dual-Eligible Special Needs Plans (D-SNPs) are among the most sweeping reforms to date, and they signal a clear shift: dual-eligible care must move from fragmented compliance exercises to fully integrated, outcomes-driven operations. For health plans—especially Medicaid-only plans—the stakes could not be higher.
Cancer will claim an estimated 618,000 lives in the U.S. in 2025, according to the American Cancer Society. Yet, despite advances in treatment, most of these deaths stem from cancers without guideline- recommended screening tests.
We all know clinicians see safety and quality as part of their professional duty. They carry the responsibility to deliver the best care possible, to avoid harm, and to give their patients the best possible experience. Yet in practice, clinicians wrestle daily with systems not optimized for safe, efficient work.
Security’s purpose in a modern hospital is to protect people while preserving dignity, calm, and clinical flow. That starts at the front door. A welcoming, consistent check-in sets expectations, lowers tension, and gives teams clear awareness of who is on site and why. Effective visitor management is now the first line of defense and a key experience touchpoint that establishes accountability at entry, versus only deep within clinical zones.
Ambulatory surgery centers (ASCs) are experiencing unprecedented growth, and so is the medical technology that powers these practices. The question that I often get from customers isn’t whether to invest in cutting-edge medical equipment.
Most hospital leaders understand the financial risk of prior authorization breakdowns. But another source of revenue leakage is gaining attention: claim denials tied to medical necessity. These denials are harder to predict, tougher to appeal, and more expensive to resolve.
Redundancy isn’t just a problem in health IT, it’s the status quo. Overlapping systems and bloated tech stacks make it difficult for healthcare leaders to identify which solutions actually drive results. Instead, health systems are flooded with digital clutter that crowds computer screens and weighs down balance sheets.
When a critical patient’s prognosis is unclear, often because they are unable to wean from the ventilator, care teams begin to discuss palliative care, advance care planning, and even hospice. Making decisions about long-term care goals can be challenging for patients and their families as they navigate the complexities of their conditions.
Value-based care promises improved outcomes for patients, healthcare providers, and health plans, and there is growing pressure for health systems to shift from a traditional fee-for-service model to a value-based approach.
In my role as a subspecialist physician, I’ve worked in diverse settings—from independent outpatient practices to academic centers and hospital systems. Each environment presents unique challenges, but one issue remains consistent: poor data.
As hospitals and health systems emerge from the pandemic-era pause on capital projects, leaders now face a difficult duality: how to fund growth while maintaining and modernizing aging infrastructure.
Cloud computing. Big data. Mobile technology. Over the last few decades—eons in tech time—organizations have invested in cutting-edge technology solutions to accelerate performance. Success is celebrated and the bar is raised again.
Pathologist shortage and recruitment, lab competitiveness and AI algorithms drive digital pathology adoption
In the most traditional definition of return-on-investment, Sam Terese, former CEO and president of Alverno Laboratories, would say that his company isn’t experiencing a strict apples-to-apples financial return on its digital pathology investment.
The Centers for Medicare & Medicaid Services’ (CMS) Transforming Episode Accountability Model (TEAM) marks a shift in surgical care reimbursement. Beginning January 1, 2026, TEAM will mandate participation for selected hospitals, making them accountable for the entire surgical episode
Non-acute providers operate in one of the most cost-sensitive environments in healthcare. Leaders face the challenge of maintaining high-quality care while navigating complex supply chains and rising patient demand.
The ability to identify patients at increased risk for hereditary cancer has never been more achievable, yet it’s still far from routine. National guidelines and accreditation programs call for proactive risk assessment and genetic testing.
In the realm of spinal fusion surgery, the quest for faster, safer, and more reliable bone formation has led to a molecular innovation that is reshaping the standard of care: P-15 Peptide. This naturally occurring 15-amino acid sequence found in type I collagen—the primary protein in bone—plays a pivotal role in initiating and accelerating the bone regeneration process.1-4
Clinician burnout may be one of the most pressing and widespread challenges in today’s healthcare environment. In the U.S., research reveals that physicians are 82% more likely to experience burnout than those in other occupations.