AI is flooding healthcare, but not all of it improves outcomes or deserves trust. For payer leaders overseeing utilization, case management and other clinical operations, the question isn’t whether to adopt AI — it’s how to evaluate the right kind.…
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Health system leaders are moving from pilots to practical results with data and AI. As ecosystems mature and generative models evolve, the focus is shifting to trusted data foundations, responsible rollout and measurable outcomes. Yet many organizations still face fragmented…
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UnitedHealth’s Optum has launched Optum Real, a real-time claims system designed to streamline the claims and reimbursement process by providing instant coverage validation for providers. “Optum Real transforms the pre-service experience in real time by delivering greater clarity and certainty…
As health systems pivot toward proactive care, the focus is shifting from disease management to personalized wellness. But making that shift isn’t easy — it demands new tech, new mindsets and new ways of defining value. Join executives from Vituity,…
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Transportation gaps, scheduling hurdles and fragmented coordination keep too many patients from getting the care they need. Behavioral health access isn’t just about volume — it’s about logistics alignment. When support systems aren’t designed around patients’ daily realities, inequities persist…
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A Colorado state audit criticized Connect for Health, a nonprofit organization that runs the state’s health insurance marketplace, for its sponsorship practices, financial management and reporting in a Sept. 16 report. The state’s General Assembly requested the audit following Connect…
As 2026 approaches, health systems are bracing for the ripple effects of the One Big Beautiful Bill Act (OBBBA), rising labor costs, and the accelerating pace of AI adoption. Leaders are being asked to improve efficiency, retain staff, and integrate…
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Point32Health, the parent company of Harvard Pilgrim Health Care and Tufts Health Plan, is laying off 254 employees in a second round of job cuts this year. In March, the company eliminated 110 positions to “reduce administrative costs as medical…
For health plans and health systems, care gaps present clinical, financial and operational challenges. Missed screenings, fragmented communication and outdated outreach methods put incentive dollars, member trust and Star Ratings at risk. But some organizations are finding a way forward.…
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Elevance Health posted a net income of about $1.2 billion during the third quarter, up 17.8% from roughly $1 billion at the same time last year, according to an Oct. 21 earnings statement. “Our third-quarter results were in line with…
