For too long, utilization management (UM) has been the most painful source of abrasion between health plans and healthcare providers.
Care decisions are too often made by third-party vendors with opaque regression algorithms trained on old data. Providers are left wondering why medically necessary care is delayed—or denied. And patients, caught in the middle, suffer the consequences. What was intended as a validation of medical necessity has become a byword for inefficiency, and a root of
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Health IT | News, Analysis, Insights - HIT Consultant
HealthEdge and UST HealthProof Merge to Modernize Health Plans
What You Should Know:
- HealthEdge and UST HealthProof have announced the successful completion of their merger, following Bain Capital's acquisition of UST HealthProof from UST.
- The combined company will operate as HealthEdge, with its headquarters in Boston. With a reach that touches over 110 million lives in the U.S., HealthEdge is now positioned to empower health plans with modern, AI-enabled technology and services that can lower total costs and improve operational
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MCG Health and Avo Launch AI Assistant to Reduce Hospital Length of Stay
What You Should Know:
- MCG Health, a part of the Hearst Health network, and Avo, a clinician-created AI platform, have launched a new AI assistant designed to tackle the challenge of hospital length of stay (LOS).
- The partnership integrates recovery milestones from MCG's proprietary guidelines directly into electronic health record (EHR) workflows using Avo's new assistant. This tool gives hospitalists and case managers a real-time picture of each patient’s readiness to go
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SoundHound AI Partners with Primary Health Solutions to Deploy AI Patient Engagement Platform
What You Should Know:
- SoundHound AI, Inc., a global leader in voice and conversational AI, has partnered with Primary Health Solutions (PHS) to deploy a new AI-powered patient engagement platform.
- The initiative makes PHS one of the first Federally Qualified Healthcare Centers in the U.S. to use AI Agents to create a more seamless and engaging patient experience.
Denise: Conversational AI Platform
The new conversational AI platform, named "Denise" in honor of a PHS
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TigerConnect Launches Transfer Solution to Modernize Patient Transfers and Discharge
What You Should Know:
- TigerConnect, the leading unified healthcare communications platform, today announced the general availability of TigerConnect Transfer, a purpose-built solution that modernizes how hospitals manage outbound interfacility patient transfers and discharge transport.
- By combining bed sourcing, transport scheduling and communication in a single application, Transfer bridges the gap between hospitals and external agencies to accelerate safe patient movement.
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HHS Announces Crackdown on Information Blocking to Empower Patients and Innovators
What You Should Know:
- The U.S. Department of Health and Human Services (HHS) has announced a new initiative to increase resources dedicated to curbing the practice of "information blocking".
- Secretary Robert F. Kennedy, Jr. has directed HHS to take active enforcement against healthcare entities that restrict patients’ access, exchange, and use of electronic health information.
Empowering Patients and Innovators
The announcement states Information blocking was not
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Reducing Healthcare Waste by Minimizing Reshipments to Clinics
An often-referenced fact is that the U.S. spends more money on healthcare than any other nation. Experts estimate that the cost of waste in the U.S. healthcare system range between $760 billion to $935 billion, about 25% of all spending. One area with strong potential for waste reduction is the minimization of reshipments to clinics. Reshipping medications to clinics is not just a logistical issue—it’s a matter of patient care and, in some cases, saving lives. Clinics frequently report missing
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AI and RCM Leader XiFin Receives New Investment, Appoints Jeff Margolis to Board
What You Should Know:
- XiFin, a leader in revenue cycle management (RCM) and billing solutions enhanced with embedded artificial intelligence (AI), today announced a new growth capital investment, as well as the addition of health IT innovator and futurist Jeff Margolis to its Board of Directors.
- The funding round builds on XiFin’s 19% year-over-year growth, driven by client adoption of its flagship next-gen platform, XiFin® Empower, and successful execution of compelling business
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Joint Ai Secures $315K to Expand AI-Powered Triage Platform for Knee and Hip Arthritis
What You Should Know:
- Joint Ai, an AI-powered triage platform for patients with knee and hip arthritis, has received a $315,000 investment from the Richard King Mellon Foundation.
- The funding will accelerate technology development, deepen strategic partnerships, and broaden nationwide access to orthopaedic surgeons.
Funding from Richard King Mellon Foundation to Enhance Technology, Partnerships, and Access to Orthopaedic Care
Arthritis represents a growing challenge for the U.S.
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Prominence Advisors Acquires Tegra Analytics to Unify Healthcare and Life Sciences Data
What You Should Know:
- Prominence Advisors, a leader in healthcare data enablement, has announced its acquisition of Tegra Analytics, a life sciences analytics consultancy. The acquisition extends Prominence's data enablement platform into the life sciences sector, strengthening its services across providers, payers, and life sciences organizations.
- The acquistion will bring together expertise from both healthcare and life sciences, along with industry-leading customer service.
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