For years, hospital finance teams have run revenue cycle on a familiar loop: a claim goes out, a claim comes back denied or underpaid, and staff spend the next several weeks working it back. That loop was manageable when denial rates held fairly steady and reimbursement was reasonably predictable. Neither of those things is true anymore, and the gap between how revenue cycle is typically run and what today's payer environment actually demands is widening fast.
Denials are climbing, and they
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Health IT & Digital Health-Opinion | Op-Eds | Guest Columns | Analysis, Insights - HIT Consultant
Pharma’s Billion-Dollar AI Bets May Be Chasing the Wrong Advantage
2026 will be remembered as the year pharma went all in on AI.
Since January, nearly every major pharmaceutical company has announced some version of the same thing. GSK signed a five-year foundation-model deal with Noetik. Eli Lilly built a co-innovation lab with NVIDIA. Merck committed a billion dollars to Google Cloud. This month, Novo Nordisk named Amazon Web Services its preferred AI partner. The dollar figures are staggering. And the messaging has been almost identical across all of
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Why Calling ICD-10 a Diagnosis Is Healthcare’s Costliest Design Flaw
Healthcare software colleagues of mine often describe a recurring discussion they have with their outsourced development teams. They recount that when they try to explain the difference between a billing diagnosis and a clinical diagnosis, the engineers on the other end deliver a common platitude: “a diagnosis is a diagnosis.”
That answer is defensible in ordinary English. In healthcare data, however, it is wrong in a way every team that accepts it inherits. The formal name of the
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When Cybercriminals Impersonate Care: Why Trust Is Part of the Treatment
For years, healthcare organizations have encouraged patients to become more digitally connected to their care.
Use the patient portal. Check your test results online. Respond to appointment reminders. Communicate electronically with your care team. Use digital tools to take a more active role in managing your health.
Patients listened.
That progress has made digital engagement an important part of the healthcare experience. Unfortunately, cybercriminals understand that relationship,
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Telehealth Was Built for Two. Interpreted Care Requires Three
Telehealth was supposed to widen access. For patients who do not speak English, it narrowed access.
An analysis of California Health Interview Survey data published in Health Affairs found that patients with limited English proficiency used telehealth at a rate of 4.8 percent, against 12.3 percent among proficient English speakers, roughly half the odds even after adjusting for other sociodemographic factors.
A systematic review by researchers at the University of North Carolina's
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Health Systems Can’t Optimize What They Can’t See: TeleTracking on Ambulatory Capacity, Leakage, and Operational AI
For decades, health systems have invested in creating operational visibility inside the hospital. Leaders are accustomed to tracking bed capacity, anticipating demand, identifying bottlenecks and coordinating the movement of patients and resources within the four walls of the hospital.
But healthcare no longer begins and ends at the hospital doors.
Care continues to move into physician practices, specialty clinics, imaging centers, ambulatory surgery centers, and at home with virtual care.
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Equitable Care Depends on Intelligent Infrastructure: Actuarial AI and Value-Based Risk Contracts
Equitable access to health care is more than just about geographical coverage. It depends on the healthcare system’s ability to identify risk early, intervene intelligently, and sustain those interventions across the most clinically and socially complex populations.
This is why many value-based care (VBC) models struggle. Underserved Medicaid and Medicare populations frequently experience a disproportionate burden of chronic diseases, behavioral health challenges, transportation barriers,
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Clinical Trial Site Selection and AI: Look-Alike Modeling Across Real-World Data and Care Delivery Signals
Site selection and enrollment failures are persistent challenges for life sciences organizations. A Tufts Center for the Study of Drug Development analysis of nearly 16,000 investigative sites across 151 Phase II and III global trials found that nearly half of all selected sites either failed to enroll a patient or under-enrolled.1 Site-selection decisions commonly draw on historical performance indicators like prior trial participation and past enrollment, typically favoring sites with an
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Why EHR Delivery Has Become a Strategic Decision: Operating Models and Clinician Burnout
For years, healthcare organizations have pursued IT cost optimization through familiar tactics: renegotiating contracts, extending hardware refresh cycles, consolidating vendors, and managing cloud spending. Those efforts can produce incremental savings, yet many organizations find themselves confronting the same financial pressures a few years later. The larger challenge is often architectural.
Increasingly, healthcare organizations are discovering that the design of their IT operating
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Most Healthcare Is Local: Connecting Epic with Regional Health Information Exchanges
Imagine a patient who arrives at the hospital for a transplant evaluation. She’s been treated at three different health systems over the past two years, seen specialists across the region, and filled prescriptions at pharmacies in two states. Her oncology navigator needs a complete picture of her care history before tomorrow morning’s appointment. Some of that data lives in our EHR. A lot of it doesn’t.
This is the reality at a tertiary and quaternary referral center. Patients arrive from
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