Clinician burnout driven by documentation burden is no longer an abstract risk; it is an operational threat to access, quality and workforce stability. The University of Vermont Health, the largest health system in Vermont, faced rising burnout rates and mounting…
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Providers, facilities and air ambulances won 88% of disputes in the first half of 2025. In January, CMS released independent dispute resolution data from the first and second quarters of 2025, including details on disputing parties and payment determinations. The…
Clinical and operational DSO leaders often see the same data but act on it differently, leading to inconsistent treatment planning and missed care opportunities. When insights live only in dashboards, opportunities are missed, case acceptance stalls and teams struggle to…
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UnitedHealth Group reported fourth-quarter and full-year 2025 earnings Jan. 27. Profits took a hit, with the company attributing drops to Medicare funding reductions, the Inflation Reduction Act, steeper medical costs and remaining Change Healthcare cyberattack costs. UnitedHealth Group Full-year revenue…
Picture a clinical environment where physicians regularly engage with their own data, discuss practice patterns openly and drive improvement together. This playbook shows how to make that culture a reality. It offers a structured, 10-step approach for physician leaders seeking…
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CMS proposed its 2027 Medicare Advantage and Part D capitation rates and payment policies Jan. 26, putting forth a slowdown in payment growth after a $25 billion boost for 2026. Six things to know:
Settling into 2026, prior authorization continues to be a contentious topic for payers, providers, lawmakers and other leaders. From piloting prior authorization in Medicare to governors pitching reforms, this year is already featuring major shifts. Here are seven prior authorization…
The new year started off strong with a handful of payer mergers and acquisitions, often known as affiliations for nonprofits. Here are five M&A moves so far: 1. North Dakota regulators approved an affiliation between BCBS North Dakota and Cambia…
When the CEO of behavioral health payer and managed care organization Magellan Health thinks about AI, its use falls into several buckets. But the verdict on whether AI can replace providers is unclear. Caroline Carney, MD, of Centene subsidiary Magellan…
Centene’s Ambetter Health has named Gautam Aggarwal, MD, as chief medical officer. Dr. Aggarwal will lead the company’s clinical strategy and help to improve care quality, chronic condition management, and optimize utilization management, according to Jan. 19 news release. Since…
