Payer

Medicare Advantage continues its rapid growth, with over 32.5 million enrollees in 2024—now representing more than half of the eligible Medicare population. [source] As the older adult population expands, payer organizations face the critical challenge of delivering highly personalized, quality care at…

CMS mandates for interoperability, patient access and prior authorization — CMS-9115-F and CMS-0057-F — are fundamentally changing how payers and providers must share data, with enforcement deadlines extending into 2026. The good news: Compliance doesn’t necessarily require ripping and replacing…

AI is flooding healthcare, but not all of it improves outcomes or deserves trust. For payer leaders overseeing utilization, case management and other clinical operations, the question isn’t whether to adopt AI — it’s how to evaluate the right kind.…

AI is flooding healthcare, but not all of it improves outcomes or deserves trust. For payer leaders overseeing utilization, case management and other clinical operations, the question isn’t whether to adopt AI — it’s how to evaluate the right kind.…

Payers face growing pressure to modernize utilization management. Between rising provider abrasion, evolving expectations from AHIP and CMS, and intensifying market competition, traditional UM strategies no longer cut it. In this on-demand session, you’ll learn what the AHIP-CMS pledge signals…

Provider network performance is now a competitive differentiator for health plans. Members expect choice and access, regulators expect adequacy and parity, and executives expect measurable ROI. The catch: artificial intelligence and machine learning only create value when the underlying network…

Payers are prioritizing tech investments but the real challenge is balance.  Reducing friction for providers while maintaining evidence-based decisions remains a critical tension. AI is now central to solving this, especially in replacing slow, manual reviews that delay care, drain…

Federal healthcare policy is shifting fast. Expiring pandemic-era tax credits, research funding cuts and increasing prior authorization pressures are already reshaping how care is delivered and reimbursed. During this virtual learning session, hear from two Cigna senior leaders on how…

Federal and state regulators are turning up the heat, especially in Medicaid and Medicare Advantage. From heightened audit activity to stricter diagnosis coding rules, payers are under growing pressure to get documentation, chart reviews and claims submission right the first…

New CMS reimbursement policies and Medicaid redeterminations are straining hospital revenue — especially in markets with high exchange plan enrollment. Health systems can’t afford to rely on legacy growth strategies. In this session, marketing, strategy and finance leaders will explore…