Here’s how finance leaders can evaluate AI investments in revenue cycle management before committing budget, and the risk exposure most vendor pitches leave out. Every healthcare CFO’s inbox now has an AI-in-RCM pitch in it. The promises are consistent: lower denial rates, faster collections, leaner overhead. What’s inconsistent is the due diligence behind the decision…

Litigation should not be the strategy to achieve Star Rating reform. It is the alarm, not the repair. Over the past two years, one health plan after another has taken the federal government to court over its Medicare Advantage quality scores—and won. UnitedHealthcare, Centene, Elevance Health, Alignment Health, and our own SCAN Health Plan have…

Dive Brief: Nearly half of physicians employed by corporations feel pressured to prioritize patient volume over care quality, according to a new survey of 1,000 doctors from a physician advocacy group. Additionally, 63% of physicians say their employers have policies that make it difficult to refer patients outside their network, and 59% say they face pressure to…

Essential to any high-performing health system is coordination of primary care with other medical care and social services that patients receive. When primary care practices, specialists, hospitals, and social service providers work in harmony, patient outcomes are optimized. Half of Americans have multiple chronic conditions, such as heart disease, cancer, stroke, and diabetes. For these patients, their…

Participation in mandatory value-based payment programs is tied to higher annual administrative costs for hospitals, according to a comparative study published in JAMA Health Forum. The analysis reviewed Medicare cost report data for different types of hospitals that did and did not participate in three mandatory programs initiated by the Centers for Medicare and Medicaid…