Payers are prioritizing tech investments but the real challenge is balance. Reducing friction for providers while maintaining evidence-based decisions remains a critical tension. AI is now central to solving this, especially in replacing slow, manual reviews that delay care, drain…
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Presented by:
Tony Oliva, DO
Chief Medical Officer, MCG Health
Kristy Stayer
Sr. Product Owner, MCG Health
Higher utilization contributed to Medicare Advantage’s $5.7 billion underwriting loss in 2024, a marked reversal from serving as a source of earnings in the last five years, said an AM Best news release covering a Sept. 23 report. “Changes to…
Pricing operations in healthcare today are grappling with issues reminiscent of the early days of electronic medical records (EMRs). In the 1990s and early 2000s, EMR systems were fragmented across departments—emergency rooms, radiology, labs—each functioning in isolation. That same siloed…
Payers are using AI to automate and deny claims faster than ever. Meanwhile, only 8% of providers use AI in denials management. This whitepaper breaks down how leading health systems including Banner Health and Houston Methodist are closing the gap…
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In healthcare, AI success will be measured not only in adoption, but in outcomes—clinical, operational, and financial. Health systems are focused on delivering patient care and improving clinician wellbeing, not conducting financial analyses. That’s why Abridge has developed customized analysis…
Presented by:
Reba Schenk
Vice President of Partner Experience, Abridge
Brian Lichtenstein
Chief Medical Informatics Officer, Sharp HealthCare
Muhammed Siddiqui
Chief Digital & Information Officer, Reid Health
Ambetter from Home State Health, a Centene subsidiary, will return $87.5 million in ACA rebates to Missouri members, according to a statement from the insurer. The rebates stem from failing to meet medical loss ratio requirements under the ACA, which outlines…
UnitedHealthcare is set to pay $359 million in ACA-required rebates for 2024, sending checks that are slated to arrive by Sept. 30, according to a news release from the insurer. Last year, commercial payers were estimated to have spent $1.1…
Several major payer acquisitions have or closed or were announced in 2025. 13 deals to note: Kaiser Permanente is entering the Nevada market through a joint venture with Reno-based Renown Health and will form a new health insurance entity with…
Expanding equitable access to cardiac care is a strategic imperative for health systems striving to improve outcomes and optimize resources. Delays in care exacerbate disease severity, increase emergency reliance, and strain staff capacity. The Imperative for new care pathways presents…
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Heart disease remains the leading cause of death in the U.S., but early detection and timely intervention remain out of reach for many — especially in rural and underserved communities. Some health systems are rethinking how care is delivered. In…
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Presented by:
Jeff Wessler, MD, MPhil
Chief Executive Officer, Heartbeat Health
Matt Brown
VP Telehealth & Advisory Services, CHG Healthcare
