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Health plans today face a structural paradox. Member acuity is rising. Workforce constraints are tightening. Administrative complexity continues to grow. Yet expectations for improved outcomes, lower total cost of care, and higher member engagement have never been greater.
25 Feb, 2026
Healthcare payers have invested heavily in analytics over the past decade. Many organizations now have predictive models in place to identify rising-risk members, anticipate utilization, and target quality improvement opportunities. Yet despite this progress, a persistent and costly gap remains.
3 Feb, 2026
This reference guide is designed to help health payers plan, execute, and track readiness activties throughout 2026 in preparation for CMS‑0057‑F compliance deadlines in 2026 and full API enforcement in 2027. It can be used as both a program roadmap and a working checklist.
15 Jan, 2026
As we move through 2026, the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) continues to reshape how healthcare payers manage data exchange, utilization management, and transparency. First finalized in 2024, the rule is now transitioning from planning to execution, making this ...
14 Jan, 2026
The healthcare payer sector stands at a crossroads. According to McKinsey’s Perspectives on Healthcare Industry Trends and the Year Ahead, payers are grappling with a convergence of macroeconomic, demographic, regulatory, and technological forces that will define the year ahead. For leaders in this ...
14 Jan, 2026
Health plans are facing mounting pressure to maintain a sustainable Medical Loss Ratio (MLR) — the percentage of premium revenues spent on clinical services and quality improvement. As medical costs outpace premium growth and regulatory requirements evolve, payers must rethink how they manage financ...
16 Dec, 2025
Recent Posts
- How Data Analytics and AI Are Redefining Care Management Staffing Ratios
- From Insights to Action: Why Predictive Analytics Alone Isn't Enough in Healthcare
- CMS-0057-F: 2026 Payer Readiness Timeline & Checklist
- Navigating the CMS-0057-F Interoperability and Prior Authorization Rule: What Health Payers Need to Know in 2026
- Payer Priorities in 2026: Strategic Resilience Meets Accelerated Transformation
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