Financial challenges are not new to healthcare. A perfect storm of converging trends has left many organizations operating within razor-thin margins in recent years.
For safety-net providers, the latest financial uncertainties introduced by the One Big Beautiful Bill Act present yet another hurdle. Many financial executives may fear making the wrong move and choose to “freeze” in response to Medicaid funding cuts that will equate to nearly $800 million.
Yet inaction is likely
Read More
Population Health Management (PHM) in Healthcare | News, Analysis, Insights - HIT Consultant
Advanced Primary Care 2026: Top 6 Investments for Health Systems According to Harvard Medical School
What You Should Know
- Harvard Medical School’s Center for Primary Care has released a comprehensive "Primary Care Investment Guide," providing the first evidence-based roadmap for deploying capital into team-based care models.
- The report identifies six critical "Advanced Primary Care" (APC) services—including behavioral health integration and e-consults—that demonstrate measurable ROI through reduced hospitalizations and improved equity.
- With the U.S. spending only 4.6% of
Read More
CMS Launches WISeR Model: New Medicare Prior Authorization Rules Start Jan. 1
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
Read More
Cornell Survey: Experts Warn HSA Conversion and Small Premiums Threaten ACA Affordability
What You Should Know:
- A new survey from the Cornell Health Policy Center reveals that 70% of health policy scholars believe converting ACA subsidies into Health Savings Accounts (HSAs) would worsen affordability for enrollees.
- Additionally, 81% of experts agree that ending automatic renewals—a policy slated for 2028 under the "One Big Beautiful Bill Act"—will substantially reduce Marketplace enrollment. These findings come as policymakers scramble to find alternatives to enhanced
Read More
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
Read More
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
Read More
The VBC Paradox: Why Hospitals Are Doubling Down on Value-Based Care While Revenue at Risk Lags
What You Should Know:
- A new report from Sage Growth Partners reveals a striking disconnect in the healthcare industry: while only 20% of C-suite leaders believe progress has been made in value-based care (VBC) recently, 77% plan to increase their participation in these models over the next two years.
- The "plot twist" indicates that despite operational hurdles and low revenue exposure today, hospital executives view VBC as essential for long-term financial survival. The data
Read More
Healthcare Costs vs. Wages: Why Premiums Are Absorbing Your Annual Raise
Healthcare costs are consuming an increasingly large share of household budgets. A RAND study found that payments to finance healthcare averaged $9,393 per person, or nearly 19% of average household income. For many families, that means more than a line item on a paycheck. It shapes the way people decide when to see a doctor, whether to fill a prescription, and how secure they feel in their jobs. A benefit once seen as a cornerstone of compensation is now a source of financial stress. For
Read More
The $4,000 Deductible Era: Why Employer-Sponsored Insurance is Breaking the American Worker
What You Should Know:
- A new 50-state analysis reveals that over half (51.7%) of U.S. private-sector workers are now enrolled in high-deductible health plans (HDHPs) as employers struggle to manage rising costs. The report shows that annual family premiums jumped to $24,540 in 2024, outpacing inflation, while average family deductibles surpassed $4,000 for the first time.
- The trend exposes millions of Americans to greater financial risk in medical emergencies, signaling a
Read More
More Safe Days at Home: A Call to Redesign Pediatric Care
For children with special health care needs, the line between stability and crisis is razor-thin. A quiet day at home can quickly spiral into an unplanned hospital admission. Even during moments of calm, families live with constant anxiety that a small change in condition could trigger the next emergency.
It shouldn’t be that way.
Time at home should be safe and supported, not a fragile pause between hospitalizations. Yet today’s healthcare system still defaults to crisis response,
Read More
