Health Plan Profitability Challenges as a Call to ActionAs 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...

Preparing Health Care Systems and Providers for Value-Based Contracting 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—...

Long-Term Optimization Strategies: Medicare Advantage 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...

End of the Medicare Advantage Gold Rush The future of Medicare Advantage 2026 and beyond 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...

Healthcare Transformation 2025 and BeyondHealthcare 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...

Artificial Intelligence for Healthcare Business OperationsArtificial 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,...

Using Fractional Leadership for Business TransformationFractional 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....

Direct Contracting in Employer-Sponsored HealthcareDirect 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...

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...

Change Management Outlook - 2025 and BeyondChange 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...

Outlook for Telehealth in the Years AheadHealthcare 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...

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...