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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Health IT | News, Analysis, Insights - HIT Consultant
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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The 2025 Margin Rally: Hospitals See Late-Year Gains Despite Soaring Drug Costs
What You Should Know:
- U.S. health systems recorded their strongest financial improvement of the year in November 2025, with median year-to-date operating margins rising to 1.5%, marking the fourth consecutive month of gains.
- Despite this stability, hospitals remain under significant pressure from rising expenses, particularly a 9.3% year-over-year spike in drug costs and increasing financial strain on physician practices. While revenue is growing, high operational costs suggest that
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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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Affordable Healthcare for Realtors: ORRA Unveils New Member Benefit with PeopleOne Health
What You Should Know:
- PeopleOne Health, a leader in value-based primary care, today announced a strategic partnership with the Orlando Regional REALTOR® Association (ORRA), one of the most innovative local real estate associations in the country, to bring affordable concierge-level healthcare directly to Central Florida’s real estate professionals.
- Through this collaboration, ORRA’s network of more than 18,000 Realtors will gain access to PeopleOne Health’s member-focused care model
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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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HCAP Partners Invests in Puzzle Healthcare to Scale Post-Acute Care Platform
What You Should Know:
- Private equity firm HCAP Partners has invested in Puzzle Healthcare to scale a post-acute care platform designed to stop the "revolving door" between hospitals and skilled nursing facilities (SNFs).
- Puzzle’s model embeds specialized physiatry providers and care managers into SNFs to coordinate recovery for 90 days post-discharge, directly tackling the high readmission rates that cost hospitals millions in CMS penalties. The funding will support national
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Catalyst by Wellstar Launches Polysight: An AI-Native Compliance Platform for Health Systems
What You Should Know
- Catalyst by Wellstar has launched Polysight, a new AI-native company designed to tackle the $39 billion annual cost of U.S. healthcare compliance.
- The platform uses validated regulatory sources and real-time data to automate what has historically been a fragmented, manual process. Currently piloting with Wellstar Health System, Polysight aims to modernize how hospitals anticipate and adapt to changing regulations without sacrificing patient safety.
$39 Billion
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WakeMed Partners with Rezilient Health to Launch Hybrid CloudClinics for Employees in 2026
What You Should Know:
- WakeMed Health & Hospitals has partnered with hybrid healthcare startup Rezilient Health to launch four "CloudClinics" in the Raleigh-Durham area starting January 2026.
- The new model allows employees to access same-day primary and specialty care via a unique blend of remote physicians beamed into clinics staffed by on-site medics and diagnostic tools.
- Initially available to WakeMed’s 12,000 employees, the service aims to reduce healthcare
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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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