Most health systems have spent the past several years expanding behavioral health access. The result has too often been the same: patients referred without clear pathways and wait lists that are many days long. Meanwhile, the financial and operational pressure…
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Hospital and health system CFOs are making some of the toughest financial calls in a generation, and the margin for error has never been thinner. With reimbursement pressures mounting and policy shifts reshaping payer mix, finance leaders can no longer…
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Blue Cross and Blue Shield of Illinois is transitioning some employees from partially to fully remote work as reports of shuttered offices mount. Throughout the spring, local outlets reported closures in Quincy, Ill., and Danville, Ill. CBS central Illinois affiliate…
Picture a CDI team that no longer spends most of its week reworking denied claims. Encounters are flagged for documentation risk while the patient is still being treated. Coders work cleaner cases. Finance can predict cash, not chase it. That…
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PacificSource Health Plans will exit the individual insurance market, as well as cease all operations in Montana, the company confirmed to Becker’s. “These are not decisions made lightly. We know they will affect people’s coverage and livelihoods, and we recognize…
The average American covered by an employer health plan is projected to spend $8,460 on healthcare this year, up from $7,838 in 2025, according to Milliman’s 2026 Medical Index released May 20. The index captures both employer and employee cost…
Mosaic Health, a national primary care venture between Elevance Health and private equity firm Clayton, Dubilier & Rice, has named Doug Wenners as CEO. Mr. Wenners most recently served as CEO of Grouper, a social fitness benefits platform, from July…
Interoperability mandates have pushed most payers to stand up FHIR APIs, but meeting the technical requirement is just the starting point. The organizations gaining a real edge are those treating FHIR as foundational enterprise infrastructure, using it to drive operational…
Three health systems have filed federal lawsuits against CVS Health, alleging the company and several affiliates improperly diverted about $250 million in savings generated through the 340B drug pricing program. The health systems include New York City-based Mount Sinai Health…
“Payviders” — health systems running their own health plans — are built on the promise of integrating care and bridging gaps between payers and providers. But, despite that compelling ethos, execution has been a challenge. In recent years, many health…
