Dental Care Alliance has appointed Doug Simpson as Chief Financial Officer and Mike Murphy as Chief Marketing Officer, strengthening its executive leadership team as the organization enters its next phase of growth.
Healthcare costs continue to rise, putting pressure on employers to balance affordability, employee satisfaction, and business performance. As a result, employer groups are looking for more than retrospective reports and utilization summaries.
Plenful, the leading AI automation platform for pharmacy teams, is ready with Rebate Intelligence. The solution gives covered entities an automated way to submit and reconcile rebates under the Health Resources and Services Administration’s (HRSA) revised 340B Rebate Model Pilot Program.
Your organization has already invested in retrieving and reviewing medical records. The retrospective coding file captures one part of the value those records contain. But what happens to the clinical information that could help your prospective team decide which conditions need evaluation next?
Healthcare procurement is under increasing strain as financial pressure collides with growing operational demands. To understand how leaders are responding, Advisory Board conducted a survey as part of its 2026 State of Healthcare Procurement research.
Patients need clear information, practical access, and support through recommended follow-up. Care teams need timely data and workflows to identify patients due for screening, engage patients, and coordinate next steps.
Most revenue cycle teams measure denials management the same way: overturn rate and dollars recovered. Those numbers matter, and a team that moves them is doing real work. But both are lagging indicators. They tell you what you won back—not why the denial happened, or whether the same one will land again next quarter.
Specialty therapies continue to transform treatment across oncology, diabetes, rare disease, and other complex disease states. From 2020 to 2025, specialty medications accounted for 75% of new drug approvals. However, developing new therapies doesn’t immediately translate into patients receiving them quickly, consistently, or successfully.
For most of my 20 years in workforce strategy, our industry has sold the same idea in new packaging: more services, more features, more data and now AI. Some of it helps. But “more” is the newest shiny object. It does not drive the results health systems need.
When primary care serves as the coordinating engine of a health system, care can become more connected, preventive and sustainable. The longitudinal relationships primary care teams build with their patients equip clinicians with a complete view of baseline health, history and social circumstances.
Operating rooms are managing more complex cases, more vendor trays and growing regulatory demands amid persistent workforce pressures. In that environment, relying on careful clinicians and manual processes alone leaves preventable gaps in surgical safety.
Health systems are facing a hard question: as site-of-care pressure pushes more infusion volume away from the hospital outpatient department (HOPD), how do they keep appropriate care inside the system?
DRG downgrades, clinical validation denials and medical necessity denials — the denials now filling most queues — share a trait: none of them dispute the care delivered. They dispute how the record reads once the case is closed, which means the argument is settled at a moment most organizations do not review.
Most of a regional plan’s commercial book now sits in arrangements that pay a fee rather than a premium, and some employers are leaving group coverage altogether. For growth leaders at regional and mid-market plans, what happens between the account decision and the renewal conversation is where retention gets earned — and where most payers have no process at all.
The No Surprises Act was built to protect patients from unexpected bills for emergency care they had no hand in choosing. That protection has held since the law took effect in 2022. But the debate over its cost impact has centered on arbitration outcomes. A new analysis suggests that framing may be missing the full picture.
With more than 35 Food and Drug Administration-approved Cell and Gene Therapies (CGT) and a pipeline that continues to expand into larger patient populations and new therapeutic areas, the CGT market has garnered rapid attention across healthcare.1 This growth is not theoretical. According to the Alliance for Regenerative Medicine, there are more than 1,700 clinical trials underway globally.2
Managing utilization review for a single hospital is demanding enough. Dr. Maliha Iqbal, MD, SFHM, CHCQM-PHYADV, ACPA-C, does it for 11 — as the sole physician advisor at Beacon Health System. Despite her caseload doubling after a merger, she closed out 2025 having completed 5,118 reviews, with a peer-to-peer overturn rate of 78%.
Colorectal cancer (CRC) screening isn’t only a clinical priority for health systems; it’s also tied directly to capacity planning, quality performance, and cost of care. Colorectal cancer is widely recognized as one of the more preventable cancers, yet screening completion continues to lag behind other cancer types.1 It’s now the leading cause of cancer death among adults younger than 50, a reversal from the early 1990s, when it ranked fifth.2 That shift matters because the disease is largely silent in its early stages, so screening, rather than symptoms, is often what catches it in time.3 Stage at diagnosis is an important predictor of survival: five-year survival is 91% for patients diagnosed at the localized stage, 73% at regional spread, and just 13% once the disease has spread further.4 For health systems, that gap is also an operational and quality-measure challenge. Despite staffing and capacity constraints, the tools to help close this gap already exist. The challenge is getting more patients through screening earlier.
For many patients with symptomatic knee osteoarthritis (OA), clinical management reaches a frustrating plateau. Having an inadequate response to conservative modalities including physical therapy, NSAIDs, and injections these patients can find themselves trapped in a treatment gap: conservative therapies aren’t providing relief and they are either not-yet indicated for, or unwilling to undergo, knee replacement.
Healthcare leaders face a growing paradox: while AI is rapidly reducing the cost of administrative work, most revenue cycle contracts remain anchored to assumptions about labor, staffing, workflows and productivity that are no longer realistic.