Insurers Committed to Cutting Prior Authorizations Have Eliminated 11% so Far
Major insurers have trimmed 11% of prior authorizations, eliminating roughly 6.5 million requests for U.S. patients, according to AHIP and the Blue Cross Blue Shield Association. The reduction is most pronounced in Medicare Advantage, where cuts exceed 15%. Insurers also report progress on data‑sharing for members who switch plans and clearer communication around approval decisions. Additional pledges target real‑time electronic authorizations and standardized processes by 2025‑2027.
Standing up to Rising Prescription Drug Costs Increases Access to Breakthrough Medications
CVS Caremark negotiated a price reduction for Yeztugo, a long‑acting injectable PrEP drug with an original list price of $28,000 per year, to improve affordability and access. The medication offers twice‑yearly dosing, which can dramatically boost adherence compared with daily...
Healthcare’s AI Inflection Point: The Organizations that Win Will Be the Ones with the Strongest Data Foundations
Healthcare AI is moving from pilot projects to enterprise‑scale execution, with 92% of early adopters already seeing positive ROI. Nearly two‑thirds of providers plan to deploy agentic AI within the next year, but fragmented data and strict compliance rules are...
Good Health and Good Data: Recognizing the Link
Healthcare’s digital transformation hinges on data quality, especially accurate patient addresses. Misspelled names, incomplete or duplicate records routinely trigger claim denials, eroding hospital revenue and inviting compliance audits. Federal initiatives like Project US@ and tools such as USPS‑CASS‑certified verification aim...
Looking Beyond Fragmentation: How Centralization Can Fix Dental Provider Data
Dental provider credentialing and directory management remain highly fragmented, leading to prolonged approval cycles—often exceeding 120 days—and widespread data inconsistencies. Studies show 81% of physician listings contain errors, and inefficient credentialing costs the healthcare sector over $1 billion annually. A centralized...
White House Seeks 12% Cut to HHS in 2027
The White House’s FY 2027 budget proposal slashes the Health and Human Services (HHS) discretionary budget by $15.8 billion, a 12.5% cut from FY 2026. The National Institutes of Health would see funding drop $5 billion to $41 billion, and several agencies—including the National Institute...
FTC Urges Tennessee to Preserve Ballad Health’s COPA
The Federal Trade Commission has written to Tennessee lawmakers urging them to keep Ballad Health’s Certificate of Public Advantage (COPA) in place, warning that its expiration would leave the state’s dominant hospital system without oversight. The Tennessee legislature is debating...
CMS Finalizes Medicare Advantage Star Ratings Overhaul, Sending Billions of Dollars More to Insurers
The Centers for Medicare & Medicaid Services finalized a rule overhauling Medicare Advantage star ratings, cutting 11 administrative metrics and scrapping the health‑equity index while reinstating a bonus system for high‑scoring plans. The changes shift the rating methodology toward clinical...
AI Scribe Adoption Linked to Modest Reductions in EHR, Documentation Time: Study
A new JAMA study of more than 8,500 clinicians across five academic medical centers found that using AI‑powered scribes shaved 13 minutes off daily EHR use and 16 minutes off documentation time per provider. The efficiency boost translated into a...
CHS Closes Sale of Alabama Hospital
Community Health Systems (CHS) has finalized the sale of Crestwood Medical Center in Huntsville, Alabama, to nonprofit Huntsville Hospital Health System for $459 million, slightly above the $450 million initial offer. The higher price reflects a post‑closing working‑capital adjustment. This transaction is...
Elevance Sidesteps Medicare Advantage Sanctions for Now
Elevance Health avoided immediate Medicare Advantage sanctions after CMS granted a deadline extension to May 30 to correct years of faulty risk‑adjustment data reporting. The regulator had warned that non‑compliance would trigger enrollment bans and communication suspensions for its MA...
HHS Reverses Biden-Era Tech Reorganization, Returns ONC Name
The U.S. Department of Health and Human Services has undone a Biden‑era restructuring, restoring the Office of the National Coordinator for Health IT (ONC) to its original name. The chief technology, AI, and data officers are being transferred from ONC...
Elevance Fills Slew of Mid-Level Leadership Positions
Elevance announced a wave of mid‑level executive appointments, adding six new leaders across its health benefits unit and the Carelon health services division. The moves include Carelon's first chief growth and strategy officer, a new president for clinical operations, and...
Duke Health Names Familiar Face as New CEO
David Zaas will re‑join Duke Health as chief executive on May 1, 2026, after a decade leading Atrium Health Wake Forest Baptist, where he oversaw eight hospitals and 27,000 employees. Zaas previously spent nearly two decades at Duke Health in various senior...
From Burnout to Breakthrough: How Healthcare Organizations Are Finally Reducing Administrative Burden
Healthcare organizations are confronting a hidden driver of clinician burnout: the massive administrative workload tied to documentation, referrals, lab results and prior authorizations. Despite widespread electronic health record adoption, billions of fax pages and manual data entry still dominate daily...
Beyond Accuracy: What “Defensible Coding” Really Means Under Today’s RADV Scrutiny
The article warns that risk‑adjustment compliance has moved beyond mere coding accuracy to require defensible, clinically‑grounded processes. Auditors now flag plans that only add codes without deletions, seeing a revenue‑driven pattern rather than true clinical documentation. AI explainability alone is...
House Democrats Accuse CMS Official of Misleading Congress Under Oath
House Democrats allege CMS COO Kimberly Brandt gave misleading testimony under oath about the agency’s efforts to engage Minnesota before withholding Medicaid funds. Brandt claimed litigation blocked a hearing, yet she later asked the hearing to be stayed, prompting Rep....
Cencora CFO Announces Retirement
Cencora CFO James Cleary announced he will retire on June 30, 2026, but will stay on as an adviser through the end of the year. Cleary, who has led finance since 2018, guided a 14% earnings‑per‑share increase and oversaw recent specialty acquisitions, including...
Healthcare Tech Innovation: Lessons From HIMSS 2026
Healthcare leaders at HIMSS 2026 highlighted how moving Epic to AWS has become a mainstream strategy, now adopted by over 50 systems across North America and Australia. The cloud foundation enabled Jupiter Medical Center to slash radiology‑scheduling backlogs by 60% and...
Why Real-Time Data Is Becoming Central to PBM Client Retention
Regulatory scrutiny and soaring drug prices are forcing pharmacy benefit managers (PBMs) to deliver real‑time data to their clients. Traditional reporting cycles of 30‑90 days leave payers reacting to problems after they occur, eroding trust and increasing churn risk. RxSense...
FDA to Unify Agency’s ‘Fragmented’ Safety Surveillance System
The FDA has launched the Adverse Event Monitoring System (AEMS), a unified platform that merges seven previously fragmented safety‑surveillance databases. Four of those databases are live today, with the remaining three slated for integration by May 2026. The agency processes...
Safety-Net Providers Tackle AI Adoption as Medicaid Cuts Loom
Safety‑net health providers are bracing for massive Medicaid cuts enacted by the recent "Big Beautiful Bill," which will strip billions from state programs and impose strict work‑requirement reporting. At the 2026 HIMSS conference, experts warned that these changes could trigger...
CVS to Pay $118M to Settle Medicare Advantage Fraud Allegations
CVS Health’s Aetna Medicare Advantage subsidiary agreed to pay $117.7 million to settle False Claims Act allegations that it submitted inaccurate diagnosis codes to boost risk‑adjustment payments. The Department of Justice accused Aetna of running a chart‑review program that added unsupported...
Providence CFO to Step Down
Providence CFO Greg Hoffman will retire in June after nearly a decade with the nonprofit Catholic health system. He joined Providence in 2016, became chief transformation officer in 2019, and was appointed executive vice president and CFO in 2021. His...
ARPA-H Launches Program to Develop Biosensors that Can Track Multiple Signals
The Advanced Research Projects Agency for Health (ARPA‑H) has unveiled the Delphi program to create modular biosensors that can monitor multiple biomarkers such as inflammation markers, hormones, and drug levels. The initiative relies on electronic "chiplet" technology, allowing developers to...
Leapfrog Must Remove Safety Grades From 5 Tenet-Owned Hospitals, Judge Says
Federal judge Donald Middlebrooks ruled that The Leapfrog Group must remove the safety grades it assigned to five Tenet Healthcare hospitals, finding the ratings deceptive and unfair. The grades, which were based on an alternative scoring system after the hospitals...
CHS to Offload 4 Hospitals in Arkansas
Community Health Systems (CHS) agreed to sell four Arkansas hospitals to nonprofit Freeman Health System for $112 million, with a projected closing date of June 1, 2026. The facilities include Northwest Medical Center in Bentonville and Springdale, Willow Creek Women’s Hospital, and...
UHS to Acquire Talkspace for $835M as Hospital Operator Pursues Behavioral Health Growth
Universal Health Services (UHS) announced an $835 million acquisition of virtual behavioral‑health platform Talkspace at $5.25 per share, a 10% premium. The deal brings roughly 6,000 clinicians into UHS’s network, addressing chronic staffing shortages that have limited growth in its behavioral‑health...
How Healthcare Leaders Are Building Procurement Interoperability
Healthcare providers, suppliers, and distributors are tackling fragmented IT systems that impede supply‑chain data sharing. Leaders at Nebraska Medicine, Heartland Dental, and Sinceri Senior Living have implemented procurement interoperability solutions—primarily through Amazon Business integrations—to automate purchase orders, gain real‑time spend...
Vinay Prasad, Controversial FDA Leader, to Again Depart Agency
Vinay Prasad, the controversial head of the FDA's Center for Biologics Evaluation and Research, will leave the agency in April after a tumultuous year marked by stricter vaccine guidelines and a new pathway for ultra‑rare gene therapies. His tenure saw...
CHS Could Slow Pace of Divestitures as It Makes Progress Paying Debt
Community Health Systems (CHS) announced it will decelerate its aggressive divestiture program as it focuses on strengthening core markets. The for‑profit hospital chain has cut its debt leverage to 6.6× in 2025, down from 7.4× the year before, and boosted...
Veradigm Cut 15% of Its Workforce in 2025
Veradigm announced a 15% workforce reduction in 2025, closed three offices and plans two more closures, and will discontinue six low‑revenue products as part of a broader turnaround. The health‑IT firm is also focused on updating its financial filings after...
Amwell Expects Lower Revenue in 2026
Amwell announced 2026 revenue guidance of $195 million to $205 million, down from $249.3 million in 2025, after divesting non‑core assets. The company has consolidated its offerings into a single, technology‑enabled care platform focused on SaaS and third‑party services. Executives said the streamlined...
