by Di Simplot | Apr, 2026 | news, Thought Leadership
Healthcare payment integrity is undergoing a fundamental transformation as we enter 2026. The healthcare industry is moving away from the traditional and more reactive “pay-and-chase” model toward a more proactive approach centered around the concept...
by Di Simplot | Mar, 2026 | news, Thought Leadership
As we head into 2026, Health Plans are facing growing profitability pressures stemming from a mix of economic challenges, regulatory complexities, and rising consumer expectations. These issues threaten the financial sustainability for health insurers and health...
by Di Simplot | Feb, 2026 | news, Thought Leadership
As the cost of medical services continues to climb, the health care industry is accelerating the move away from traditional fee-for-service payment models—where reimbursement is based on the quantity of services delivered— toward value-based payment systems. These...
by Di Simplot | Jan, 2026 | news, Thought Leadership
In this second in our two-part series on the future of Medicare Advantage, we will cover longer term strategies for sustained success in light of both the internal and external challenges highlighted in our first article on this topic.In order to maximize...
by Di Simplot | Dec, 2025 | news, Thought Leadership
Medicare Advantage (MA) plans have long been a cornerstone of growth and profitability for major insurers, buoyed by generous federal reimbursements, aggressive medical services coding strategies, and enticing member benefits. However, the landscape is shifting...
