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Blogs

Clinical Platform Transformation: Reducing Cost of Care with AI & Digital Health

Health plans and managed care organizations are dealing with unprecedented complexity heading into 2026. Rising costs, D-SNP regulations, and changing Medicaid policy are constantly reshaping how payers must operate. And at the same time, members expect better care coordination, faster responses, and truly digital-first engagement options while still receiving the value that only human interactions can provide. Review high-level tactics for clinical platform transformation and reducing cost of care via new technologies to build resilient, compliant, and scalable operations.

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Tip Sheets

2026 AI-Driven Utilization Management Strategies

The Centers for Medicare & Medicaid Services is advancing new rules that directly address the use of artificial intelligence in utilization management and prior authorization. These regulations put a spotlight on transparency, auditability, and fairness, shaping how payers, providers, and members experience UM. For managed care organizations, this is an opportunity to align operational efficiency with compliance while building trust through responsible AI integration. Learn more by requesting the free tip sheet.

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Blogs

Care Management in Uncertain Times: Value-Based Approaches for Dual-Eligibles

As 2026 approaches, healthcare leaders continue to grapple with the volatility of policy shifts, regulatory oversight, and evolving care models. Nowhere is this uncertainty more visible than in the management of dual-eligible populations: individuals enrolled in both Medicare and Medicaid. Review D-SNP-specific strategies that can help health plans strengthen dual-eligible care management in 2026.

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Blogs

Preparing for CMS‑0057‑F: What Managed Care Organizations Need to Know

The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) is a sweeping federal regulation with major implications for managed care organizations (MCOs). With the first deadlines approaching in 2026, this rule introduces both technical and operational changes that are intended to improve the speed, transparency, and coordination of prior authorization processes. Take a closer look at what CMS‑0057‑F includes, what it requires from MCOs, and how organizations can begin planning for compliance.

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Blogs

Comparing BPaaS Providers to Find Your Best-Fit Partner

For health plans and managed care organizations, the right BPaaS providers can be more than vendors. They function as strategic partners equipped to drive operational efficiency, compliance, and scalable growth. But with so many options available, selecting BPaaS solutions can be challenging. This guide explores the key challenges in choosing BPaaS providers, the critical criteria to evaluate, and actionable steps for conducting provider assessments.

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Blogs

From Bottlenecks to Flow: Achieving Clinical Workflow Efficiency Through BPaaS

BPaaS helps optimize clinical workflows by automating routine administrative tasks, reducing manual entry, and encouraging smoother coordination across systems and teams. This model reduces the friction that can slow down healthcare operations and lets staff focus on the clinical priorities that drive outcomes and compliance. Cloud-based BPaaS service models are reshaping how healthcare teams manage complexity.

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