Delayed wound care drives avoidable costs — and for payers, those costs can be substantial. Each year, U.S. health plans spend billions on wound-related treatment, complications and prolonged care episodes. New real-world data from more than 15,000 patients shows how…
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The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) represents a significant compliance lift. However, payers have the opportunity to leverage the rule as a means to accelerate broader transformation. From streamlining prior authorizations to integrating clinical, claims and SDOH…
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With CMS-0057 on the horizon — and growing friction with providers and members — health plans know utilization management needs more than a tune-up. But fragmented systems, outdated policies and poor access to clinical data continue to slow progress. In…
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Traditional automation can only go so far in solving today’s operational and compliance pressures. As costs rise and member expectations grow, payers need a smarter path forward. This e-book introduces agentic automation — a new approach that blends human judgment,…
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Many payers still rely on brokers to manage nonemergency medical transportation (NEMT). This model is rife with inefficiencies, including misaligned incentives, fraud risk, outdated workflows and lack of data visibility. Missed appointments, access delays and rigid advance-notice requirements can increase…
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Employer healthcare costs are expected to spike 8% in 2025 — the steepest increase in a decade. Yet many HR and benefits teams are navigating this surge without a full view of what’s driving costs or where to intervene. This…
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Healthcare costs are expected to hit $6.2 trillion by 2028, putting immense pressure on insurers and employers. Without proactive measures, unpredictable expenses, budget shortfalls and premium hikes are inevitable. The good news? AI can turn the tide on rising costs…
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Generative AI (GenAI) has the power to transform healthcare, but most organizations aren’t ready. Leaders are facing major hurdles — disorganized data, a lack of AI expertise and difficulty forging the right strategic partnerships. A recent study found that even…
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