Every day, payers deploy artificial intelligence (AI) into claims and prior authorization with the hope of eliminating delays, rework, and provider friction. Yet, too many are still seeing clean claims sent back for missing context, prior authorizations stalled over data that already exists, and a need for continued manual reviews because systems can’t agree. These disappointments stem from one root cause: payers are deploying AI as tools, not as infrastructure.
Without integration across
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The Missing Discipline in Healthcare Modernization
Modernization in healthcare is usually measured by what gets implemented next: an ERP platform replaced, EHR systems consolidated, a database moved to the cloud. But a successful go-live does not equal successful modernization. The full value of a new investment is only captured when the legacy system it replaces is permanently shut down.
The “shutting off” is where the work often breaks down. The team responsible for the new implementation is understandably focused on getting the replacement
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Why AI Finally Changes the Math on Fraud, Waste, & Abuse in Healthcare
The U.S. health care system loses more than $100 billion a year to fraud, waste, and abuse, and by some estimates several times that. We have known this for decades. What is new is that the technology to catch it has finally caught up. The question is no longer whether the tools work; it is whether the institutions processing and paying the faulty claims will finally use them.
What the system is actually losing
Three different problems get lumped together, so it is worth
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The Real Truth About Zero Data Retention: What AI Coding Tools Actually Promise in a HIPAA-Compliant World
A developer on your team is debugging a scheduling algorithm. They paste a function into an AI coding tool that references a patient's Medicaid eligibility window. Did that data just get retained? Logged? Used for training? For most engineering leaders, the honest answer is: they don't know.
That knowledge gap has a cost. IBM's Cost of a Data Breach Report found that 63% of organizations lack formal AI governance policies, and as AI tooling becomes embedded in everyday development
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The Future of Pharmacy Procurement:
From Purchasing Function to Data-Driven Strategy
With drug prices soaring, shortages intensifying, and government-mandated cost-sharing in question, hospital-system pharmacy procurement is becoming an increasingly fraught enterprise. Pharmacy leaders are routinely expected to deliver on critical outcomes, including financial performance, operational resilience, and regulatory readiness.
Health systems – with margins currently hovering around 2% and cash reserves plummeting – are pressuring pharmacies to shore up institutional viability.
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How AI is Helping Healthcare Leaders Translate Patient Experience Data into Action
Every time a patient visits a healthcare facility, there is a treasure trove of information about their experience that could improve patient safety measures and lead to better outcomes.
Patients’ care experiences go far beyond clinical care. A patient recovering from surgery for a few days may interact with more than a dozen providers, specialists and staff. The patient may be moved from a surgical unit to a medical unit or an inpatient rehabilitation facility. They may be discharged
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Pharma Is Deploying AI Faster Than It Can Understand Its Risk
A year ago, integrating AI-powered clinical workflow tools could take months of review and planning across disparate teams within a pharmaceutical company's IT, security, and risk teams. Today, with the proliferation of tools that have less than a month of onboarding and can provide immediate value to clinical teams, the way risk is approached has changed. For better or worse, AI capabilities are outpacing the security programs meant to govern them, and many companies are simply assuming risk
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Combined GI Endoscopy Has a Quality Assurance Gap. At Current Volume, That Gap Has Institutional Consequences.
Combined GI endoscopy is already standard practice across many US health systems. When both procedures are clinically indicated, around 65% of patients undergo them in the same session or close window: one prep, one sedation, consolidated throughput.
The efficiency logic is sound, but what the operational analysis hasn't fully accounted for is the risk that sits inside that efficiency gain. Upper GI and lower GI are not equivalent procedures in their quality infrastructure. Colonoscopy has
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Healing Without Drugs: A Promising Future for Alzheimer’s Patients
Of the medical diagnoses that cause anxiety, sorrow, and despair for patients and their loved ones, Alzheimer’s is near the top of the list. An incurable condition that slowly robs people of memory, identity, and independence, Alzheimer’s puts immense financial and emotional burdens on families.
That may be changing for more than 7 million Americans living with the disease, and the hundreds of thousands more who are newly diagnosed each year. A new wave of scientific and technological
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OBBBA Requirements | Behavioral Health Clinics Must Modernize Their Technology Now
The implementation of the 2025 One Big Beautiful Bill Act (OBBBA) left community clinics that rely on Medicaid patients at a critical juncture. The bill introduced new policy variables that will affect clinics unevenly across the country, with facilities in Medicaid expansion states likely to experience a more pronounced impact.
CEOs and leadership teams face significant decisions. What are the bill’s most pressing provisions? How are Medicaid expansion and non-expansion states affected
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