In the News

Stories and trends changing the healthcare landscape

The Evolving Healthcare Delivery System Transformation

The Evolving Healthcare Delivery System Transformation

Healthcare Transformation 2025 and Beyond

Healthcare transformation has experienced renewed momentum in recent years, largely driven by the increasing demand for care and the continued high cost of providing it, along with ongoing innovation within the healthcare industry.

The demand for care is rising alongside significant inflation in labor, drug, and supply costs for hospitals and health systems. This has created pressure to shift care delivery to lower-cost ambulatory settings, such as urgent care and other outpatient facilities, where technology and advancements in pharmaceutical therapies enable a broader range of services to be delivered outside traditional inpatient environments.

Operational AI Uses

Operational AI Uses

Artificial Intelligence for Healthcare Business Operations

Artificial Intelligence (AI) is transforming healthcare operations by automating tasks, optimizing resource allocation, and improving overall efficiency. AI-powered systems can handle administrative duties like appointment scheduling, billing, and patient record management, thus freeing up staff for more critical tasks. Furthermore, AI can predict patient needs, optimize staffing levels, manage inventory, and even assist with medical imaging analysis and diagnostics.

Fractional Leadership

Fractional Leadership

Using Fractional Leadership for Business Transformation

Fractional Leadership refers to the practice of hiring seasoned executives on a part-time, project-based and/or contract basis.

This leadership model has grown rapidly in popularity, especially among startups and small to mid-sized businesses. It gives organizations access to top-tier executive talent while remaining financially agile and operationally flexible.

Increasingly, senior executives who have reached a point in their careers where work/live balance begins to take center stage, are stepping out of high-powered roles and opting instead to seek work on a “pay as you go” basis as fractional leaders. Post-pandemic shifts in work practices (such as working remotely) have also altered how many senior leaders think about time, values, and balancing priorities. For some, it is the allure of being able to continue to make significant business contributions on a more part-time basis balanced with the ability to work around personal and family priorities.

The Rise of Direct Contracting in Employer-Sponsored Healthcare

The Rise of Direct Contracting in Employer-Sponsored Healthcare

Direct Contracting in Employer-Sponsored Healthcare

Direct contracting in healthcare, particularly between employers and providers, has been a growing trend driven by the desire to manage rising healthcare costs and improve quality of care via a more direct and transparent relationship between plan sponsor and provider(s). 

This approach allows a plan sponsor or employer to directly negotiate with healthcare providers, bypassing traditional insurance intermediaries like PPOs and HMOs. This model is particularly attractive to self-funded employers who bear the financial risk of their employees’ healthcare costs.

Mental Health Parity

Mental Health Parity

Mental Health Parity – the journey ahead

Mental Health is a vital component of overall well-being, yet not everyone has equal access to the care and support they need. Mental Health Parity encompasses the principle that all individuals deserve access to high quality, affordable mental health services. Achieving parity will require addressing systemic barriers, establishing inclusive, supportive elements that enable all individuals to seek the care they need in a safe and equitable manner.

Accessibility includes physical location, availability of providers, insurance coverage, and inclusive practices – reducing the stigma associated with mental health care seeking and cultural sensitivity for marginalized populations in need of services.

Change Management

Change Management

Change Management Outlook – 2025 and Beyond

Change management has long been a leading consideration for forward looking organizations, but with the rapid pace of business transformation in recent years, it is becoming even more critical. New trends in change management are emerging, driven by things like AI and digital transformation, evolving workforce expectations, and the growing importance of sustainability relative to organizational strategy.

Telehealth

Telehealth

Outlook for Telehealth in the Years Ahead

Healthcare organizations wanting to remain on the forefront of virtual care opportunities are well advised to take a fresh look at the future of telehealth with an eye toward formulating a more deliberate, strategic approach, particularly given the persistently higher rate of telehealth usage post-pandemic.

Medicaid Changes and Challenges for Health Plans

Medicaid Changes and Challenges for Health Plans

There are both immediate and longer-term changes that set forth an uncertain and multi-dimensional framework for health plans and provider organizations to consider as they think about individuals served and ways to plan for and/or mitigate the health care consequences for the diverse groups of individuals served who may be at risk.

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Combatting Fraud in Healthcare

Combatting Fraud in Healthcare

Fraud in healthcare billing and payment continues to be a serious risk for payers and providers alike. Billions of dollars are misappropriated every year resulting in increasing costs throughout the healthcare delivery system.

Public and private payers are serious about rooting out fraud, waste, and abuse in the health care system wherever it may occur, given the magnitude of the problem.

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Medicare Advantage – Part 2

Medicare Advantage – Part 2

Headwinds and Strategies to Weather the Storm

The Medicare Advantage market appears to be at a critical crossroads. The past few years have seen unprecedented enrollment growth, fueled by a rapidly increasing over 65 population and a favorable regulatory environment. The unprecedented growth from prior years has now slowed down and conflicting trends converging on Medicare Advantage organizations are expected to continue to result in more tempered growth going forward.    

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