A Mandatory Shift: Why the CMS TEAM Model Is an Important Opportunity for Health Systems
On Jan. 1, 2026 the Centers for Medicare & Medicaid Services launched the Transforming Episode Accountability Model (TEAM), a mandatory alternative payment model covering five high‑cost surgical episodes. The first year is upside‑only, allowing health systems to develop episode‑based processes without downside risk, while year two introduces up to 20% downside risk. Executives who invest now can build care‑management, standardization, and cross‑continuum collaboration capabilities that will protect margins and position them for future value‑based mandates. Delaying action risks margin compression and competitive disadvantage.
Designing a National-Scale FHIR API Ecosystem Using Apigee: Architecture Patterns for Secure Healthcare Interoperability
Healthcare data remains fragmented despite widespread EHR adoption, prompting costly manual workarounds. The Fast Healthcare Interoperability Resources (FHIR) standard offers a modern, REST‑based solution, but scaling it nationally introduces authentication, consent, and compliance challenges. Google Cloud’s Apigee API management platform...
Provider-Payer Tensions Brew in Courtrooms: 3 Recent Lawsuits
Provider‑payer friction is spilling into the courts as health systems sue insurers over alleged underpayment. The California Hospital Association filed a suit against Anthem, claiming a 10% payment reduction for hospitals when out‑of‑network physicians treat patients. Broward Health is suing...
Parsley Health Wins Greater Insurance Coverage for Its Functional Medicine
Parsley Health announced it is now in‑network with major insurers nationwide, joining Aetna, Cigna, UnitedHealthcare, BlueCross BlueShield, Humana and Centene. The rollout expands coverage to roughly 150 million Americans, a tenfold increase from its earlier state‑by‑state pilots. The functional‑medicine platform reports that...
How I Learned To Trust AI as a Physical Therapist
Steven Griffin, a senior manager at TailorCare, describes his shift from skepticism to embracing AI in musculoskeletal (MSK) physical therapy. He explains that while MSK care’s nuanced, trust‑based nature resists full automation, AI tools—such as motion‑tracking, documentation scribes, and decision‑support...
Kidney Care Is Value‑Based Care’s Toughest Economic Test — and It’s Working
Value‑based care has finally proven its worth in the most complex segment of U.S. healthcare—kidney care—through the Comprehensive Kidney Care Contracting (CKCC) program. Since its launch in 2022, CKCC participants have posted early shared savings, profitability, and measurable clinical improvements....
Is the Atrium-WakeMed Merger Already Hitting a Wall?
North Carolina’s two largest health systems, Atrium Health and WakeMed, announced a $2 billion merger that would create 3,300 jobs in Wake County. The Wake County Board of Commissioners postponed its vote, citing transparency and cost concerns raised by the state...
Why EHRs Are Critical to Effective Revenue Cycle Management
Electronic health records (EHRs) are emerging as the backbone of modern revenue cycle management (RCM) in hospitals, turning clinical documentation into a financial engine. Legacy, paper‑heavy processes cause delays, fragmented data, and manual charge capture that erode cash flow. By...
Sleep Is the Missing Vital Sign, and Health AI Is Scaling the Consequences
Sleep is increasingly recognized as a missing vital sign that predicts chronic disease, cognitive decline, and burnout, yet it remains measured inconsistently in clinical practice. Wearable devices have democratized sleep tracking, but device-to-device variability and adherence gaps undermine data reliability....
Top 7 Modern AI-Powered EAP Providers for Global Workforces in 2026
Traditional employee assistance programs are used by only 1‑3% of workers, prompting a surge in AI‑powered EAP solutions that promise higher engagement and faster care. Providers such as Spring Health, Kyan Health, Lyra Health, Modern Health, Unmind, Wysa and Yuna...
The Power of Real World Data to Study Women’s Health at Scale
Veradigm released its 2026 Women’s Health Report, leveraging real‑world evidence from its network of electronic health records linked to claims data. The report maps health trends across adolescence, reproductive years, and peri/post‑menopause, highlighting disease risk, comorbidities, and treatment patterns unique...
The Evolving Medical Practice: How Doctors Can Adapt and Prosper In a Changing Environment
Physicians are confronting delayed reimbursements, rising labor and supply costs, and heightened cyber risk. The article proposes three resilience pillars: tighten accounts‑receivable to keep cash flow within a 35‑40‑day window, fortify digital defenses through annual HIPAA risk assessments and multifactor...
The Biosimilar Market Isn’t Failing, It’s Finding Its Purpose
The biosimilar market is not collapsing; it is transitioning from a price‑driven scramble to a purpose‑focused strategy. Recent HHS data show that markets become uneconomic once five competitors vie for the same molecule, prompting a shift toward diversified product portfolios....
The AI Funding Divide: Why VCs Will Miss the Next Healthcare Category Kings (And Where CEOs Should Look Instead)
The article warns that venture‑capital firms now rely on large‑language‑model agents to triage thousands of life‑science pitches, a process that amplifies familiar patterns and sidelines truly novel healthcare ideas. This bias, dubbed the “AI Funding Divide,” means breakthrough categories can...
Why Clinical Digital Out-of-Home Displays Are Healthcare’s Most Untapped Advertising Opportunity
Clinical digital out‑of‑home (DOOH) screens sit in waiting rooms where patients are fully attentive to a health concern, yet they are priced at the same CPM as mass‑media channels that cannot guarantee an audience. Studies show point‑of‑care ads generate 84%...
The Multimodal Explosion: Why 2026 Breaks the AI Paradigm
In 2026 AI transitions from isolated tools to multimodal platforms that fuse transcripts, labs, notes, and device data, closing the "Synthesis Gap" in clinical workflows. This integration enables "minimal‑click" medicine, surfacing critical information in real time and freeing clinicians to...
Why Metabolic Health Is a Common Thread Across Diabetes, Heart Disease, and Some Cancer
Metabolic health underlies a spectrum of chronic illnesses, from diabetes and cardiovascular disease to chronic kidney disease, fatty liver disease, and certain cancers. The article explains that insulin resistance and erratic glucose‑insulin spikes drive these conditions, and that flattening these...
Healthcare Moves: A Monthly Summary of Hires, Exits and Layoffs
The healthcare sector saw a flurry of senior appointments this month, with Aledade, Humana, and several med‑tech firms adding former industry leaders to C‑suite roles. ChristianaCare promoted its chief strategy officer Jenn Schwartz to CEO, signaling a planned leadership transition....
MedCity FemFwd: Inside Partum Health’s Partnership with UChicago Medicine
Partum Health has partnered with UChicago Medicine in Hyde Park to provide 24/7, Medicaid‑reimbursed doula support for labor, delivery, and postpartum care. The program offers in‑person doulas without referrals, aiming to improve birth outcomes and patient satisfaction for a largely Medicaid‑eligible...
Avalyn Pharma Takes a Breath to Raise $300M in IPO Cash for Lung Drug Trials
Avalyn Pharma completed a $300 million IPO, pricing 16.6 million shares at $18 each and listing on Nasdaq under the ticker AVLN. The Boston‑based biotech will use the proceeds to advance inhalable versions of pirfenidone (AP01) and nintedanib (AP02), plus a combination...
Why Protocol Complexity Keeps Increasing – and How to Fix It
Protocol complexity in late‑stage trials is spiraling, with Phase III studies now averaging about 6 million data points—a rise of roughly 11% each year. The growth is fueled by scientific advances, global regulatory demands, and the ease of capturing extra data via...
Repurpose, Don’t Replace: Three Ways Digital Agents Are Improving Phone Access
Healthcare providers are grappling with long hold times and high call abandonment, with 60% of patients hanging up after a minute. AI‑enabled digital agents are being deployed to handle routine administrative calls, freeing staff for complex, empathetic interactions. Early adopters...
Musculoskeletal Disorders Are Draining Employer Health Budgets — The Workplace Itself May Be the Cause
Musculoskeletal (MSK) disorders now represent one of the largest cost drivers for employers, affecting roughly half of workers with company‑provided health plans. Up to $90 billion in avoidable expenses stem from surgeries—many of which are unnecessary—and recurring pain after treatment. The...
Why Some Hospitals Won’t Be Able to Comply With Upcoming HIPAA Updates
The Department of Health and Human Services will finalize the first major HIPAA overhaul in more than a decade, scrapping the distinction between “required” and “addressable” rules and making every security provision mandatory. New mandates cover two‑factor authentication, data encryption,...
4 Notable Health Tech Funding Announcements in April
In April, health‑tech firms attracted sizable capital, underscoring investor confidence in AI‑driven and patient‑focused solutions. Chapter raised $100 million in a Series E round, pushing its valuation to $3 billion as it tackles Medicare plan mismatches. AcuityMD secured $80 million in Series C funding to...
AI-Driven Layoffs In Healthcare: Navigating Legal Risks and Operational Challenges
Artificial intelligence is accelerating workforce reductions across sectors, and healthcare is feeling the impact. Large employers such as Amazon, UPS and Verizon have announced tens of thousands of AI‑related cuts, while a Utah physician‑owned network and CVS Health have trimmed...
Financial Assistance Reform Is Reshaping Revenue Cycle Strategy
In 2026 a wave of state financial‑assistance reforms turns hospital affordability from guidance into enforceable law. Laws such as Maine’s LD 1937 require mandatory income‑based payment plans, pause collections during eligibility review, and impose multilingual disclosures. Similar statutes in Maryland, Oregon,...
Beyond Support Teams: The Strategic Role of Centers of Excellence in Healthcare
Healthcare systems are channeling new technology dollars into Centers of Excellence (COEs) to tackle workforce shortages, regulatory pressure, and EHR fatigue. A COE is positioned as a governance and execution model that aligns technology choices with clinical, financial, and operational...
Executing Biologics Technology Transfer Through Integrated Operating Models
The article advocates replacing the traditional sequential biologics tech‑transfer model with an integrated operating model that colocates development, manufacturing, MSAT and quality teams. By running small‑scale experiments and large‑scale runs concurrently, organizations can observe scale‑dependent effects in real time and...
Digitizing Medical Policy Alone Will Not Automate Prior Authorization at Scale
The CMS Interoperability & Prior Authorization rule now obliges health plans to digitize medical policies and expose them via FHIR APIs, but merely putting policies online hasn’t accelerated prior‑authorization turnaround. Availity’s EVP Matt Cunningham argues that true automation requires translating...
As Health Costs Hit Record Highs, Brokers Face a Structural Test
Health insurance premiums surged to their highest level in more than a decade, pushing employers to reevaluate benefit strategies. Over 60% of firms are now actively shopping carriers or pharmacy benefit managers, and nearly half are exploring level‑funded, ICHRA or...
Why Healthcare AI Still Can’t Scale — and How Nvidia & Hoppr Are Trying to Fix It
Healthcare AI adoption is hampered by deployment and scaling challenges, prompting Nvidia and Hoppr to pivot from building standalone models to creating an AI foundry infrastructure. The foundry leverages Nvidia’s computing power and pre‑trained foundation models, allowing hospitals and radiology...
CEO of For-Profit MA Plan Tells CMS “Pay Us Less”
Devoted Health CEO Ed Park told CMS at the Medicarians conference that the for‑profit Medicare Advantage (MA) plan would welcome lower government payments. He cited MedPAC’s March report showing MA enrollees cost the federal government $76 billion more than traditional Medicare....
Timely by DrFirst Aims to Lower Barriers to Specialty Meds
Timely by DrFirst unveiled a provider‑focused solution that embeds actionable insights directly into e‑prescribing workflows. The tool boosts prior‑authorization (PA) completion to 60% for specialty drugs and cuts pharmacy change requests by 56%, while patient‑facing text messages achieve an 88%...
Intellia’s Data Reveal Tees Up FDA Filing for CRISPR-Based In Vivo Gene-Editing Med
Intellia Therapeutics filed a rolling FDA submission for lonvo‑z, its CRISPR‑based in‑vivo gene‑editing therapy for hereditary angioedema (HAE). In a placebo‑controlled Phase 3 trial of 80 patients, a single infusion cut swelling attacks by 87% versus placebo and left 62% of...
What Dentistry Is Teaching Healthcare About Operational AI
Artificial intelligence is moving from isolated pilots to core operations across healthcare, but fragmented systems are turning speed into inconsistency. Dentistry, with its tighter reimbursement cycles and integrated workflows, is serving as an early proving ground for operational AI that...
How Recent Changes in ‘Patient-Matched’ Technology Are Reshaping the Future of Surgical Care
Advances in CT, MRI and AI-driven modeling are enabling patient‑matched medical devices that are designed around each individual's anatomy rather than using standard sizes. These bespoke implants and surgical guides improve anatomical concordance, cut intra‑operative adjustments, and can shorten procedure...
Too Many Prescriptions, Too Many Fatal Falls
U.S. seniors are facing a surge in fatal falls, with 41,000 deaths recorded in 2023, while the proportion taking multiple prescriptions has climbed dramatically. Four in ten older adults now use five or more drugs, and more than 7.5 million are...
Why Some Hospitals Are Betting on Midstream Health to Help Eliminate Waste
Midstream Health, a San Francisco AI startup founded in 2023, helps hospitals slash expenses by consolidating fragmented financial and operational data. Its platform uncovers missed rebates, prevents over‑paying for supplies, and streamlines contract verification. Major systems such as Mount Sinai,...
Novartis Antimalarial Clears Key WHO Review to Get the Combo Drug to Babies
Novartis’s Coartem Baby, the first antimalarial specifically designed for infants, has cleared the World Health Organization’s pre‑qualification review, allowing public‑sector and donor agencies to procure the drug in regions lacking robust regulatory systems. The formulation, a liquid‑dissolvable, cherry‑flavored version of artemether‑lumefantrine,...
Driving Outcomes with a Digital Transportation Infrastructure
Healthcare consumers now demand the same speed and convenience they get in everyday life, and transportation barriers still prevent more than five million Americans from receiving timely care. Legacy non‑emergency medical transportation (NEMT) programs rely on phone queues and manual...
Healthcare’s Identity Crisis: Why A Single Prescription Requires Multiple Logins
Healthcare providers are hampered by fragmented identity systems that force patients, clinicians, insurers and other stakeholders to juggle multiple logins for routine tasks like prescription refills. The article highlights that the average 2025 data breach in the sector costs $7.42 million,...
The Quiet Revolution Comes Full Circle: How CMS ACCESS Validates Safety-Net Innovation
CMS announced the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, a ten‑year, national demonstration beginning July 2026 that validates the asynchronous e‑consult approaches pioneered by safety‑net health systems. The model introduces Outcome‑Aligned Payments, rewarding Medicare‑enrolled organizations for measurable...
‘Prior Authorization’ Has Become a Dirty Word in Healthcare, But It Might Be Medicare’s Smartest Path Forward
The CMS‑backed WISeR model launched a six‑state pilot on Jan. 1 to overhaul Medicare prior authorization using AI. It targets 17 procedures prone to fraud, waste and abuse, promising decisions in under three days versus the traditional 30‑day lag. Payment to...
Beyond the Scale: How Imaging Can Help Determine GLP-1 Efficacy
The GLP‑1 drug class now reaches roughly 12% of U.S. adults, making it one of the fastest‑adopted therapies in recent history. Critics argue that weight alone is an inadequate measure of success, prompting Hone Health to partner with imaging startup...
The Cancer Crisis We Can See Coming And Have the Tools to Change
Colorectal cancer has become the leading cause of cancer death for Americans under 50, with survival dropping sharply when diagnosis is delayed. A one‑month postponement of treatment raises mortality risk by more than 12 %, and a three‑month delay can increase...
Precision Delivered: How Radiopharmaceuticals Are Reshaping Cancer Care
Radiopharmaceuticals, especially alpha‑emitting agents, are emerging as precision tools that deliver high‑LET radiation directly to cancer cells while sparing healthy tissue. Building on decades of beta‑emitter use, alpha therapies generate dense DNA damage and are less dependent on tumor oxygenation....
The Brand-Driven Flywheel: Igniting Growth Through a Simple Patient Experience
The article argues that legacy patient‑support models are outdated and proposes direct‑to‑patient (DTP) platforms as a brand‑driven flywheel for growth. DTP unifies access, fulfillment and support into a single, tech‑enabled journey, cutting prior‑authorization delays and improving adherence. With specialty drugs...
SCAN CEO Urges Brokers to Drop Plans That Treat Them Poorly — One Says She Has No Choice
At the Medicarians Conference, SCAN Health Plan CEO Sachin Jain urged brokers to abandon for‑profit Medicare Advantage plans that cut commissions and instead partner with not‑for‑profit carriers. He framed the plea as self‑interest, noting the recent 2.48% Medicare Advantage rate...
MedCity Pivot Podcast: Modernizing Prior Auth
The MedCity Pivot podcast featured Abarca Health’s Javier Gonzalez and Amazon Pharmacy’s Tanvi Patel discussing how to modernize prior authorization. They highlighted three pillars—policy complexity, data quality, and operational risk—and explained that electronic prior authorizations (ePA) could cut 60‑70% of...