Payer

Rising costs, specialty drug pressure and Medicare Advantage headwinds are making sustained medical loss ratio performance harder to achieve. At many health plans, risk, quality, network and value-based initiatives are still managed through disconnected analytics tools or spreadsheets. This fragmentation…

Value-based care programs generate no shortage of insights. The problem is turning those insights into action, consistently and at scale. As downside risk grows, organizations face thousands of coordinated tasks across quality, care management and utilization management. Manual outreach, siloed…

More than 60 percent of U.S. adults report difficulty accessing timely primary care, driving delayed treatment, higher downstream costs and avoidable escalation. Primary care access gaps are growing, and payers are increasingly looking to AI-enabled models to close them without…

Today’s group health market is defined by complexity: rising costs, changing risk profiles and heightened expectations from brokers and employers alike. Carriers need more than standalone risk scores; they need complete visibility and control. But too many are stuck with…

HEDIS season shouldn’t require all-hands-on-deck for months at a time — yet many health plans report rising burnout, staffing strain and mounting pressure to hit quality targets with fewer resources. Leaders need a way to stay ahead of deadlines without…

Health plans are under growing pressure to improve accuracy, accelerate recoveries and reduce waste. AI is helping meet that challenge — not by replacing workflows, but by making them more intelligent and responsive. By analyzing structured and unstructured data, from…

Medicare Advantage continues its rapid growth, with over 32.5 million enrollees in 2024—now representing more than half of the eligible Medicare population. [source] As the older adult population expands, payer organizations face the critical challenge of delivering highly personalized, quality care at…

Provider network performance is now a competitive differentiator for health plans. Members expect choice and access, regulators expect adequacy and parity, and executives expect measurable ROI. The catch: artificial intelligence and machine learning only create value when the underlying network…

Payers are prioritizing tech investments but the real challenge is balance.  Reducing friction for providers while maintaining evidence-based decisions remains a critical tension. AI is now central to solving this, especially in replacing slow, manual reviews that delay care, drain…

Federal healthcare policy is shifting fast. Expiring pandemic-era tax credits, research funding cuts and increasing prior authorization pressures are already reshaping how care is delivered and reimbursed. During this virtual learning session, hear from two Cigna senior leaders on how…