This spring, the American Medical Association (AMA) and dozens of physician groups sent federal officials a letter detailing how health plans are circumventing the No Surprises Act — through inappropriate cost-shifting, IDR manipulation, depressed QPAs and unpaid awards. For pro-fee…
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Many mental health apps covered by health plans today are built on general-purpose AI — the same models designed to write emails and summarize documents. Those models are trained to be agreeable and validating. In a mental health context, that…
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Most healthcare organizations have a cyber crisis plan. Few have one that holds up when an attack disrupts operations at scale. The gap often comes down to identity infrastructure, the foundational layer that governs access to every critical system. When…
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A federal judge in Georgia has ruled in favor of Clover Health in its lawsuit challenging its 2026 Medicare Advantage star ratings. In a May 27 opinion, U.S. District Judge Lisa Godbey Wood partially granted the insurer’s motion for summary…
UnitedHealthcare plans to remove about two-thirds of its prior authorization requirements for patients under 18 by the end of 2026. The insurer said May 29 the cuts will cover diagnostic services, routine surgical procedures, and specialty care across pediatric subspecialties…
Blue Cross Blue Shield of Massachusetts returned to profitability in the first quarter of 2026, posting a net income of $59.6 million on $2.6 billion in revenue. For the company’s CFO, Ruby Kam, the result was meaningful, but one worth…
CVS Health’s insurance branch will roll out “Aetna Mental Health On Demand” in 2027, the company said in a May 28 news release. Aetna members who are at least 13 years old will be able to access licensed clinicians via…
The U.S. Department of Veterans Affairs delivers more than 127 million healthcare appointments annually while managing a massive, years-long EHR modernization effort. At the same time, clinicians across the system are facing growing documentation demands, workforce shortages and the cognitive…
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Every minute a stroke goes unrecognized, a patient loses an average of 2 million neurons. Yet fewer than 30% of acute ischemic stroke patients are treated within the first hour — when treatment is most effective. The gap isn’t always…
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Every health system was built around one constraint: the scarcity of human expertise. That constraint is lifting, and every leader is feeling the same tension. How do you solve for today’s problems while preparing for a future that looks nothing…
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