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The UM Reset: Rethinking MSK Cost Control

Musculoskeletal (MSK) spending keeps climbing faster than expected. Prior authorization (PA) does what it’s built to do: screen claims and stop the wrong care from being delivered at the point of service. But by the time a member is in…

Dec 8, 2026 1:00 PM - 2:00 PM CST

Presented by:

Presenters:

Traci Granston, MD, VP Clinical Innovation & Trend, Quality & Cost Strategy (QCS), Humana
Nick Kings, VP & GM, Specialty Risk Solutions, Carelon
Rachel Winokur, CEO & Founder, TailorCare

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Medicare Advantage insurers expanding, shrinking SNP footprints in 2027

While some payers are slimming down their Medicare Advantage reach, some are betting big on special needs plans. SNPs cover dually eligible Medicaid individuals (D-SNP), those with chronic conditions (C-SNP) and those needing long-term care (I-SNP). CMS released data Sept.…

‘You need to look into it’: Dr. Oz pitches CHOICE health plans to small businesses

CMS Administrator Mehmet Oz, MD, is urging employers to consider an alternative to traditional group health plans that allows workers to select their own individual insurance coverage. Speaking Sept. 30 at an event in Austin, Texas, Dr. Oz promoted CHOICE…

Judge narrows California pension fund lawsuit against UnitedHealth

A federal judge has thrown out most of a securities fraud lawsuit brought by the country’s largest pension fund against UnitedHealth Group, but will let claims that the company misled investors about previous asset sales move forward. The California Public…

How agentic AI puts every goal within reach: Lessons and outcomes from UTMB Health, Hawai‘i Pacific Health, and ECU Health

Every health system has goals it would pursue if it had the capacity: close every gap in follow-up care, get patients to the right specialist sooner, keep quality reporting complete and on time, protect the revenue it earns for care…

Nov 10, 2026 11:00 AM - 12:00 PM CST

Presented by:

Presenters:

Eren Alkan, VP of Forward Deployed, Bunkerhill Health
Dr. Peter McCaffrey, VP & Chief Digital + AI Officer, UTMB
Dr. John Hanna, Associate Chief Health Information Officer, ECU Health
Dr. James Lin, Vice President Information Technology, Hawaii Pacific Health

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300% ROI, no new hires: How Wellstar Health System scaled IT support through a merger

A merger brought three hospitals and thousands of new employees into Wellstar Health System — including clinicians learning Epic for the first time. Support requests surged overnight. With hospital margins under pressure, adding headcount was not an option. Instead, Wellstar…

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Baylor Scott & White margin dips to 8.3% as health plan exits Medicaid, individual markets: 5 notes

Dallas-based Baylor Scott & White Health reported operating income of $1.5 billion (8.3% margin) during the fiscal year ending June 30, 2026, down from a $1.7 billion operating gain (10% margin) in the previous fiscal year, according to financial statements…

Independence Blue Cross to pay $22.5M over Medicare Advantage coding

Independence Blue Cross has agreed to pay $22.5 million to resolve allegations that it used inaccurate diagnosis codes to inflate its Medicare Advantage payments, according to a Sept. 30 Justice Department news release. The government alleged the insurer violated the…

Blue Shield of California must face mental health ‘ghost network’ claims

A federal judge allowed portions of a putative class action lawsuit against Blue Shield of California and Magellan, the insurer’s contracted mental health services administrator, to move forward over allegations that they published an inaccurate directory of mental health providers,…

Beyond the Bed: How Hospitals are Solving Complex, Hard-to-Place International Discharges

Some of the costliest patients in your hospital are the ones who are ready to leave but impossible to place. Legal, transportation and logistical barriers can keep a single case open for days or weeks, tying up beds while consuming…

Sep 3, 2026 11:00 AM - 12:00 PM CDT

Presenters:

Craig Poliner, Founder & CEO, MedEscort International
Mark Weller, Lawyer, Polsinelli

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