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Blogs

AI-Enabled Prior Authorization: Balancing Automation & Clinical Judgment

Health plans are already implementing AI-driven workflows to process requests faster, reduce administrative workload, and improve consistency in utilization management. But how far should automation go? Rather than treating AI as a replacement for clinicians, these systems use automation to handle predictable tasks while reserving human expertise for complex medical decisions. When implemented thoughtfully, this hybrid model can improve efficiency while protecting the clinical integrity of the authorization process.

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Blogs

The Future of Medicaid Managed Care: What States & National Payers Need to Prepare For

Medicaid managed care is entering one of its most volatile financial and regulatory cycles in recent history. After years of enrollment growth and relative margin stability, the combined effects of post–public health emergency redeterminations, new federal policy changes, and state fiscal pressures are reshaping the market at speed. Review the national Medicaid trends, regulatory inflection points, and managed care strategies that will define performance through 2026 and beyond.

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Blogs

Medicaid Unwinding & ACA Coverage: Capturing Members in Transition

Members losing Medicaid are not disappearing. Many remain eligible for coverage through Affordable Care Act Marketplace plans, Basic Health Programs, or other subsidized options. The organizations that act early, coordinate across programs, and meet members where they are stand to retain lives, stabilize risk pools, and build long-term loyalty. Understand how Medicaid unwinding is reshaping coverage transitions and what it means for retaining members moving to ACA options.

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Blogs

Provider-Owned Health Plans: Evolving Models in a Constrained Market

Many provider-led plans have been closed, sold, or unwound as health systems reevaluate capital requirements, regulatory burden, and whether insurance operations align with core business priorities.2 As a result, provider-owned plans are not expanding uniformly but persisting primarily where market structure, scale, and Medicaid dynamics support long-term viability.2 Take a closer look at emerging business models, risk-sharing strategies, and key considerations for payers.

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News

Kevin Swagerty Joins Clearlink Partners as Executive Vice President, Technology Solutions

Kevin joins us as Executive Vice President of Technology Solutions, bringing deep expertise as a technology strategist and extensive experience applying innovative technologies to transform healthcare organizations.

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Blogs

PCCP for Payer AI: Governing UM & Claims Model Updates in 2026

Most health plans have moved past debating whether artificial intelligence belongs in utilization management and claims operations. The harder question is how to manage change. UM and claims models retrain, recalibrate, and adjust as policies shift, data changes, and performance issues surface. Yet governance structures often assume stability. That mismatch is now one of the most common sources of compliance risk for payer AI.

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