Latest
The Sustainability of the Healthcare System
The sustainability of the healthcare system won’t be secured by another round of cost-cutting or clever benefit design alone, but by a hard cultural pivot toward alignment: payers, providers, employers, and patient advocates pulling on the same rope instead of grading each other on different exams. Right now we’ve built a maze that…
Allow Doctors to Provide Care Without Making Patients Fight the Insurance System
Patients shouldn’t have to become their own case managers just to access a hip replacement, transplant, or any other life-changing procedure; the moment they’re pushed into a paperwork fight, the system has already shifted its burden onto the sick. In a functional healthcare model, clinicians and their teams handle the insurer negotiations behind…
The Impact of Physician Advisors on Hospital Revenue and Patient Advocacy in a Payer-First Era
Physician advisors are becoming the quiet linchpin of hospital resilience in a reimbursement environment where insurers increasingly treat care like a spreadsheet exercise. As payers tighten criteria and automate denials, the gap between clinical reality and business logic widens—and without a skilled physician advisor (and a disciplined appeals pathway), health systems risk watching…
How Hospitals Can Defend Against Payer Denials Without Sacrificing Patient Care
Payer denials used to feel like a series of personal affronts—clinicians and administrators trading war stories in hallways, certain they were being shortchanged but lacking the proof to do more than fume. Today, that fog should be lifting: with data warehouses, smarter analytics, and years of claims history, hospitals can pinpoint which payers…