Iowa Republican Gov. Kim Reynolds signed a law May 13 that enacts prior authorization reforms and prohibits insurers from penalizing providers for out-of-network referrals, according to the Iowa Hospital Association. Under the law, while initial prior authorization reviews can be…
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Payers nationwide are striving to operate more efficiently, while maintaining high levels of member and provider satisfaction. Success stems from reducing the friction and costs associated with core processes, like utilization management, appeals, medical necessity research and documentation for newly…
Allentown, Pa.-based Lehigh Valley Health Network is no longer in network for UnitedHealthcare employer-sponsored commercial members, as of April 26, according to both organizations. The update does not impact access to broader Philadelphia-based Jefferson Health facilities and physicians, the insurer…
Most payer organizations agree AI will reshape underwriting, claims and operations. But many initiatives still struggle to move beyond isolated pilots. The challenge is no longer whether AI matters. It’s how to operationalize it responsibly. This new white paper examines…
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Froedtert ThedaCare Health, a 20-hospital system based in Menomonee Falls, Wis., has appointed Seraphine Kapsandoy-Jones, PhD, RN, chief nursing executive and senior vice president. Dr. Kapsandoy-Jones will join the system June 15 after serving Centene as vice president of population health and…
Former Cigna Group executive Eric Palmer has been named to the board of directors for healthcare staffing company AMN Healthcare. Mr. Palmer spent more than 25 years at Cigna before departing the company in April 2025. He held several senior…
EMS reimbursement pressures are rising as audits, denials and documentation scrutiny intensify across the industry. As payer analytics become more sophisticated, EMS organizations are facing growing pressure to justify every transport, document every modifier accurately and prevent revenue leakage before…
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For small and rural hospitals, today’s interoperability requirements are reshaping where revenue cycle pressure lands first: at the front end. Real-time eligibility verification, advance explanations of benefits and faster prior authorization aren’t just technology updates, they are operational shifts that…
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Alignment Healthcare founder and CEO John Kao will take on the company’s chairman role in addition to his current responsibilities, according to a May 12 news release. Former chairman Joseph Konowiecki has been named vice chairman and executive vice president…
Cardiovascular risk assessment is evolving, with the 2026 ACC/AHA Dyslipidemia Guideline now recommending that every adult have lipoprotein(a) — Lp(a), an inherited cardiovascular risk factor — measured at least once in a lifetime. The 2026 American College of Cardiology/American Heart…
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Presenters:
- Donald M. Lloyd-Jones, MD, ScM, FAHA, FACC
- Frank Qian, MD, MPH