Earlier this year the Centers for Medicare and Medicaid Services introduced the "Wasteful and Inappropriate Service Reduction" model, a series of prior authorization requirements designed to ensure timely and appropriate Medicare payment for select items and services in six states (New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington) that take effect Jan. 1.
As part of the “WISeR” requirements, CMS selected tech vendors to implement enhanced technological models to
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AI Nutrition Labels: The Key to Provider Adoption and Patient Trust?
At the frontline of patient care, providers have been put under impossible pressure to lead the charge for AI within healthcare. This is not a sustainable way to move the needle towards increased AI innovation for healthcare as a whole. Providers require a familiar frame of reference, collaboration with a broader network to build effective standards, and tools that will help translate the impact of innovation to patients and ensure safety.
The healthcare industry is finally on the brink of a
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Is Your Agency Next? Why Behavioral Health Leaders Can’t Ignore Cybersecurity
Many behavioral health agencies lack adequate controls to address and recover from a cybersecurity incident. What these agencies need are capabilities such as adequate backup and recovery, managed detection and response (MDR), security information and event management (SIEM), data loss prevention and other key security elements. Without these tools, agency leaders cannot identify a security incident and remedy or recover their IT environment.
In a 2024 report, the Ponemon Institute, an IT
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Combatting Patient Aggression: How Vocal Biomarkers Can Protect Hospital Staff in 2026
Patient aggression in the hospital is a growing problem. Among nurses and other staff, violent or abusive behaviors have been linked to burnout and PTSD — two of the many reasons nurses have left the medical profession in recent years by the thousands. Preventing aggressive behavior before it can begin is perhaps the most effective, and elusive, strategy for reversing the trend.
Here’s a closer look at the problem
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Retail Pharmacy 2026 Forecast: From “Hard Truths” to AI-Driven Innovation
2025 has been a year of hard truths for retail pharmacy.
Persistent reimbursement pressures, escalating fees, workforce shortages and policy whiplash have forced many operators to rethink how they serve patients and sustain their businesses. Expanding into clinical services and stepping into the role of frontline healthcare providers is becoming an expectation, not an option. Direct-to-payer contracting is no longer experimental.
But perhaps the most palpable change for
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Why Rural Health Transformation Must Include Maternal Health
Congress’ most recent budget reconciliation bill included controversial cuts to Medicaid spending. The legislation slashed hundreds of billions of dollars from the program over the next decade, a move that is likely to disproportionately affect rural hospitals and safety-net providers.
To offset the cuts, lawmakers introduced the $50 billion Rural Health Transformation Program (RHTP), a five-year initiative (2026-30) meant to
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5 Ways AI Can Go Beyond Optimization in Healthcare Marketing in 2026
Artificial intelligence (AI) has already proven its worth in healthcare marketing by optimizing campaigns—refining targeting, improving efficiency, and reducing waste. But optimization is only the beginning. Its real value lies in creating tangible advantages—extending human capabilities, enabling precision at the point of care, simplifying complex compliance requirements, and bridging the gap between treatment and access. Here are five ways AI can and should transform healthcare marketing
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Prenatal Compliance: Solving SDOH Needs Builds Trust with Moms
Pregnancy is one of the most-expensive episodes for insurers, averaging about $19,000 for pregnancy, vaginal delivery and postpartum care, and $26,000 for cesarean births. Compared with other industrialized nations, costs in the U.S. are nearly eight times higher.
And what do mothers in the U.S. get in return for this high-priced care? They get the highest death rate per 100,000 live births in the developed world, with 18.6 deaths recorded in 2022, compared with 5.5 deaths per 100,000 in the
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The Invisible Gap: Why Oncology EHRs Must Measure Emotional Recovery
In oncology care the clinical community has made remarkable progress in extending survival. Yet we face a persistent invisible gap in care: the emotional and cognitive recovery of patients after treatment ends. Emotional distress in cancer survivors such as anxiety, depression, and pain is not only common but also has measurable impacts on utilization, adherence, and quality of life. The next frontier in digital health is to treat this recovery as a data-driven outcome by embedding it into the
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Denial Management: Closing Gaps and Reducing Revenue Leakage
Revenue leakage on the front end and mid-cycle is an ongoing challenge for hospitals and health systems. Rather than taking a reactive approach to the problem, proactively collaborating among teams prior to admission helps providers avoid playing the blame game when their claims are denied after the fact.
By focusing on reducing the number of denials before a claim is submitted, rather than trying to eliminate denials after the fact, revenue cycle managers can save time and energy. Today’s AI
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