After an abnormal cancer screening, it takes an average of 156 days to reach diagnosis — a delay that increases costs, worsens outcomes and exposes gaps in care. This report outlines a new model: shifting clinical intervention earlier in the cancer…
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Eight out of ten Americans turn to search engines or general-purpose LLMs at least once a month for medical questions. Yet physician-led evaluations show some AI chatbots deliver unsafe or harmful responses in up to 43% of cases, creating new…
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Nearly half of consumers access healthcare portals less than once a month, and 16% say they have never used one. For payer organizations investing heavily in digital member portals, this gap between availability and engagement raises an important question: What…
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Consumer demand for virtual care continues to grow — and expectations are expanding beyond episodic care. New research shows insured adults are increasingly open to using virtual care across a broader range of needs, yet real‑world use has not fully…
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Musculoskeletal conditions are among the largest cost drivers for Medicare Advantage plans. As populations age, surgical interventions and downstream utilization continue to drive spending — even when conservative care options may be appropriate. A new analysis of Medicare Advantage members…
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Today’s Medicare Advantage payers are navigating rising enrollment, changing HCC models and heightened audit scrutiny from CMS. At the same time, quality standards continue to tighten, putting Star Ratings and revenue at risk when documentation and coding fall short. This…
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Payer leaders are managing deeper downside risk, tighter margins and rising expectations for transparency, quality reporting and audit readiness. This guide outlines a practical framework for using AI in value-based care while managing compliance and operational risk. Rather than focusing…
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Health plans are under pressure to improve member engagement while managing rising costs and increasing expectations around personalization. Medicare Advantage and Medicaid members are no longer passive recipients of benefits. They are consumers with clear preferences for flexibility, ease of…
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2025 exposed hard truths: Denials surged. Trust collapsed. And affordability became the dominant barrier to care, not just on the Exchange and among the uninsured, but across Medicare Advantage and commercial plans alike. This 2026 outlook unpacks the forces reshaping…
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Musculoskeletal spend is a top driver of healthcare costs—but it’s also one of the few areas where plan-year savings are realistic when AI-care is applied early. New research shows that when members begin MSK care through an AI-enabled, virtual-first care…
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