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What external payer data demands for value-based care and AI

Bring external payer data into a health system and it can look like a one-time integration project — connect, map, deliver, done. It rarely works that way. Teams must track expected files, validate incoming data, interpret payer-specific formats, reconcile claims…

Sep 25, 2026 12:00 PM - 1:00 PM CDT

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Presenters:

Rob Pinataro, CEO, Health Data Innovations
Christopher Ragsdale, Founder and Principal, Towers Advisory
John Supra, Founder and Managing Member, Better Health Matters
Jonathan Kaye, Founder and Executive Chairman, Health Data Innovations

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Employer healthcare costs to top $19K per worker in 2027: 5 things to know

Aon projects U.S. employer healthcare costs will rise 9.5% in 2027, pushing average costs above $19,000 per employee, according to an Aug. 20 report from the professional services firm. Five things to know: 1. The projected 9.5% increase would mark…

Oregon budgets $15M for ACA stabilization, eyes enrollment caps in 2027

Oregon regulators have approved individual ACA market rate increases that average 21.6% for 2027 coverage. In the small group market, the state reduced insurers’ proposed average rates from 17% to 15.5%, with some reductions of up to 8%, according to…

EmblemHealth issues cease-and-desist to Mount Sinai over new patient policy

EmblemHealth issued New York City-based Mount Sinai Health System’s independent practice association a cease-and-desist letter regarding its decision to stop accepting new patients from some of the insurer’s government-backed plans. The insurer sent Vincent Tammaro, Mount Sinai’s executive vice president…

'We're in wartime': As major insurers continue pulling back on Medicare Advantage, SCAN places another contrarian bet

As insurers nationwide prepare to take their latest Medicare products to market this fall, SCAN Group is doubling down on an unconventional growth strategy meant to grab the attention of seniors and healthcare leaders alike. “You can’t solve a problem…

Where reimbursement risk really starts in a specialty revenue cycle

Federal auditors found that 13 percent of the prior authorization requests Medicare Advantage plans denied met Medicare coverage rules, care that likely should have been approved. The pressure that creates lands on the revenue cycle. This report shows how health…

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Denial problems start before the patient arrives

Hospital revenue loss rarely begins with a bad claim. It often begins days or weeks earlier, when a service is scheduled before authorization requirements are confirmed, documentation is incomplete or the final service no longer matches what was approved. That…

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Senate Democrats call on feds to halt Medicaid data sharing with ICE

Senate Democrats on Aug. 17 called on federal officials to end Medicaid enrollee data sharing with the Department of Homeland Security and Immigration and Customs Enforcement. Sens. Ron Wyden, D-Ore., Jeff Merkley, D-Ore., Edward Markey, D-Mass., Cory Booker, D-N.J., and…

Why perioperative staffing is a deployment problem, not just a hiring one: Inside OHSU’s shift

A fully staffed perioperative team is essential to safe, efficient surgical care — and rising procedural demand, clinician shortages and anesthesia constraints keep testing it. But workforce shortages are only half the problem. The other half is deployment: getting the…

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BCBS Tennessee pivots away from AI program that monitored employee work

BlueCross BlueShield of Tennessee has moved away from AI software that monitored employee work, according to an Aug. 19 report from the Chattanooga Times Free Press. The insurer confirmed to Becker’s that it recently ended a pilot based on employee…