Many payer agreements lack provisions that would give hospitals greater visibility, predictability and recourse in the face of denial risk.

The latest Kaufman Hall Report includes a short case study on Geisinger’s utilization management transformation as well as a short interview with Columbia Memorial's CEO on a rural...

Trump administration continues transparency push, Hinge Health’s splash IPO, CMS looks for Medicare Advantage fraud.

For many health systems, utilization management (UM) has long been a functional necessity, but rarely a strategic priority. Originally designed to ensure clinical appropriateness and support payer requirements, UM often grew up within hospital walls, shaped by local workflows and embedded within broader care management structures.

In today’s volatile healthcare landscape, CFOs are being called to step beyond traditional financial management and embrace a transformative leadership role.

Changes in operations and services, coupled with the need to invest more in patient-facing services, require health systems to assess corporate shared services to maximize efficiency and cost-effectiveness.

As healthcare looks to another period of uncertainty — namely the impact of potential tariffs on its supply chain — it’s important to remain vigilant, keep informed and be purposeful about next steps

The proliferation of claims denials, especially by Medicare Advantage payers, has become a pressing issue for health system operations.