I Don’t Care

SHMS Optimizes Operations for Medicare Advantage Plan Operators in the Healthcare Payer Enterprise

healthcare payer enterprise

Enrollment in Medicare Advantage plans is projected to reach about 35.7 million, according to a 2025 Senate Finance Committee report. Yet, many startup and midsize organizations face steep technical and regulatory hurdles when launching or scaling operations. As part of the broader healthcare payer enterprise landscape, these plans must manage compliance, claims adjudication, risk adjustment,…

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Latest

Healthcare
HealthSearch Partners’ Neill Marshall and Kurt Mosley Urge New CEOs to Listen First, Diagnose Early, and Lead with Purpose in the First 90 Days

CEO turnover across U.S. hospitals is accelerating. Hospitals and health systems announced 146 CEO changes in 2023—a 42 percent increase over the 103 exits recorded in 2022, according to a Challenger, Gray & Christmas report. As more leaders transition into new roles, the importance of making a good first impression has intensified. The early…

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Healthcare
Rewriting the Odds: Leadership Resilience at the Heart of Norberto Orellana’s Rise

Economic mobility is often portrayed as a straight climb. In reality, it’s shaped by adversity, identity, and access to opportunity. As research from the University of Michigan notes, mobility requires not only income, education, and employment, but also more intangible resources such as social inclusion and power—the ability to make choices and exert influence….

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Healthcare
AI-Powered Care Navigation Reduces Healthcare Spend and Improves Patient Access

The U.S. healthcare system is strained by rising costs, uneven quality, and fragmented care navigation. Employers are bearing the brunt, spending more without always securing better care for their teams. According to the RAND Corporation, one effective strategy is to “change their network and benefit designs to encourage patients to use lower‑priced, higher‑value providers…

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Healthcare
Healthcare Operations Improve with AI That Unites Data, Automation, and Ethics

Generative AI has captured the public imagination, but its most transformative use cases may lie far from flashy consumer tools. In healthcare operations, where complexity, inefficiency, and fragmentation remain persistent challenges, AI is now driving measurable improvements. Research suggests AI-enabled healthcare systems could cut administrative costs by up to $360 billion in the U.S. alone….

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Articles Healthcare
2025’s Hottest Healthcare Trends with David Willis, Principal with ECG

Healthcare organizations have faced significant challenges over the last five years due to the lasting financial and operational impacts of the COVID-19 pandemic, widespread labor shortages, and rising costs of care delivery. The pandemic forced hospitals to prioritize crisis response over long-term strategy, leading to deferred investments, workforce burnout, and financial strain. Now, with many…

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Articles Healthcare
Private Equity and Venture Capital Are Transforming Healthcare – But at What Cost?

Private equity and venture capital have been reshaping the healthcare landscape, with $47 billion in related deals recorded from 2019 to 2023. These investments promise innovation and growth in AI, diagnostics, and healthcare delivery. However, they also raise critical questions about aligning profit-driven goals with the mission to improve patient care and system efficiency….

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Latest

Marketplace Inclusion
How TEKsystems Uses Marketplace Inclusion to Drive Equitable AI Adoption
July 16, 2025

As organizations race to integrate AI into every corner of business, an equally urgent conversation is emerging: How do we ensure this adoption doesn’t widen existing equity gaps? AI is both a disruptive force and an opportunity engine, as recent data shows that AI adoption among HR professionals jumped to 72 percent in 2025, up…

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storytelling
The Secret to Brand Loyalty: Why Storytelling Is the Best Way to Be Heard in a Crowded Market
July 16, 2025

In today’s fast-evolving digital marketplace, attention is scarce, and trust even more so. In an era of remote work, AI-driven marketing, and constant digital noise, storytelling has emerged as one of the most powerful tools to cut through the clutter. In fact, research shows that people who used storytelling techniques to remember information recalled seven…

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hospitality career development
Leaders Driving Hospitality Career Development Must Embrace Tech, Inclusion, and Risk
July 16, 2025

The hospitality industry is under mounting pressure to modernize to meet guest expectations for seamless, tech-driven experiences and also develop leaders who can drive that transformation. According to Rackspace Technology, only 28% of travel and hospitality companies qualify as “AI leaders”— those aligning strategy, compliance, and training with real-world deployment. Another 28% remain in…

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HR compliance
Seeing What Others Miss: The Art of Problem Solving in HR Compliance
July 16, 2025

In this episode of Professional Quotient: Conversations that Build Equity, host Jason Winningham sits down with Andrea Kilburn, the HR EEO and Affirmative Action Compliance Manager at EssilorLuxottica. Andrea has built her career on problem-solving, advocacy, and the power of precise thinking. Andrea shares her unique path from mortgage underwriting to HR compliance, and…

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Other I Don't Care
Employer-Built Healthcare Plans: Controlling Costs and Transforming Care
February 12, 2025

The rising cost of healthcare continues to strain employers and employees alike. With premiums climbing at a rate outpacing inflation, many organizations are burdened with high costs and subpar outcomes. Employer-built healthcare models are emerging as a potential solution, enabling organizations to take control of their healthcare systems. According to the Kaiser Family Foundation,…

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AI and Advocacy Unite: Tackling Women’s Health Disparities with Hologic Mia Keeys
February 5, 2025

Women’s health remains a critical issue globally, with alarming disparities in access and outcomes. A new survey from Hologic and Gallup reveals that while nearly 90% of women recognize the importance of health screenings, less than half undergo them consistently due to barriers like cost, time, and anxiety. The stakes are particularly high in…

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Overcoming Behavioral Health Challenges: Iris Telehealth’s Technology-Driven Approach
January 29, 2025

Behavioral health challenges have intensified nationwide, with wait times for care stretching months and access in rural areas remaining inadequate. Telehealth innovations are emerging as a crucial bridge to close these gaps, particularly in behavioral health. The stakes are high and according to the 2023 National Survey on Drug Use and Health (NSDUH), 22.8%…

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Market-Based Planning, Specialization and Technology To Shape Healthcare Provider Networks for Tomorrow
January 22, 2025

The evolving healthcare landscape demands that provider networks strike a careful balance between meeting community needs and maintaining financial sustainability. As patient demographics shift and technological advancements, such as telehealth, redefine care delivery, health systems must recalibrate their networks to avoid inefficiencies. A 2024 AAMC study highlights this urgency, projecting a shortage of up…

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AI-Powered Remote Cardiac Monitoring Improves Care Access, Disease Detection, and Diagnostic Accuracy
January 15, 2025

Advancements in artificial intelligence are transforming healthcare, and remote cardiac monitoring is at the forefront of this change. With cardiovascular disease impacting nearly 50% of the population at some point in their lives, early detection and efficient diagnosis are crucial. Enter AI-powered cardiac monitors that provide near real-time data, reduce diagnostic errors, and improve…

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Patient Physician Network Provides Financial Integration and Value-Based Care Support to Keep Independent Physicians Viable.
October 22, 2024

As healthcare systems continue to consolidate, independent physicians are facing unprecedented challenges in maintaining their viability. Rising operational costs, shifting value-based care metrics, and payer pressures are squeezing independent doctors more than ever before. Nearly 80% of physicians are now employed by hospitals, health systems, or corporate entities, up from previous figures of 60%,…

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MedCurate’s Transparent Marketplace is Tackling the Healthcare Staffing Crisis, Backed by Mentorship
October 22, 2024

Staffing challenges in healthcare continue to grow, with burnout and workforce shortages creating increasing pressures on hospitals and healthcare facilities. The current staffing solutions are often seen as inefficient, with traditional agencies taking large cuts, and clinicians feeling underpaid. According to the American Hospital Association, workforce shortages remain one of the top challenges for…

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The Key to Value Based Care Success is Integrating Specialists for Better Outcomes
October 22, 2024

Value-based care (VBC) is critical to the evolving healthcare landscape. As the U.S. population ages and healthcare costs continue to rise, achieving value-based care success has become a primary goal for the system, which seeks to optimize care while maintaining financial sustainability. According to the Centers for Medicare & Medicaid Services (CMS), by 2030,…

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Authenticx Tackles Healthcare Challenges Using Conversational Intelligence
October 22, 2024

Healthcare systems are under immense pressure to improve patient experiences while simultaneously reducing costs and administrative burdens.  Healthcare organizations are finding innovative ways to listen at scale and unlock insights buried in patient conversations with the growing integration of artificial intelligence (AI). In a landscape where AI is often seen with skepticism, technologies that…

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