Insights

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Insights Briefing | AI CatalystHealthcare Leader’s Guide to AI Policy in 2025

Explore the fragmented landscape of AI policy in healthcare amid stalled federal action and a surge in state-level legislation. Discover how leaders can navigate liability and align innovation with evolving regulatory demands.

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Policy Brief | Health Impact AllianceHIA Policy Briefing: CY2026 Medicare Physician Fee Schedule (MPFS) Proposed Rule

Review proposed health equity updates in the CY2026 MPFS rule, including social needs screening in a new mandatory Center for Medicare and Medicaid Innovation (CMMI) model

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Policy Brief | Health Impact AllianceHIA Policy Briefing: CY2026 Outpatient Prospective Payment System (OPPS) Proposed Rule

Review finalized health equity requirements in the CY2026 Outpatient Prospective Payment System (OPPS), including the rescission of social drivers of health (SDOH) screening measures from quality reporting programs

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Newsletter | Executive Insight HubWiSeR Takes On Prior Auth. Can It Deliver?

On June 27, CMS’s innovation arm, CMMI, announced the launch of the Wasteful and Inappropriate Service Reduction (WISeR) pilot starting Jan 1, 2026. For a pre-selected set of procedures and services, the model will use AI and machine learning to review and determine appropriateness of service before approval. The pilot will apply only to Medicare. Critics claim that the approach is reminiscent of what commercial payers have already adopted and are concerned about the impact on patient care. While much remains to be seen, it is clear that the challenge of preauthorization is not going away. This opens both a competitive opportunity and a compliance imperative.  

Why It Matters for Industry  

  • CMMI is actively encouraging industry participation: Companies already streamlining prior authorization have a clear path to partner with health systems as WiSeR takes shape 

  • WiSeR will accelerate demand for tools that modernize prior auth processes. As health systems prepare for Medicare’s new process, expect growing demand for  –  

    • Automated auth submissions and status checks 

    • Time-to-approval tracking 

    • Seamless integration with EHRs and scheduling workflows 

    • Essentially, any solutions that close the gap between today’s workflows and tomorrow’s AI protocols 

  •  Shifting front-end workloads will necessitate solutions to lessen the load: If WiSeR functions like commercial payer systems, providers could see new documentation requirements and rework risks. Partners can help reduce that load with AI-powered tools that integrate with EHRs or auth portals.  

  • Changing Denial Patterns = Need for Adaptive Solutions: Even as AI aims to speed approvals, it may introduce new denial patterns tied to opaque algorithms. Partners that can flag WiSeR-specific denials and help tune systems in real time will become essential. 

Key Questions to Ask  

  • Is your tech WiSeR-compatible—both functionally and from a federal compliance standpoint?  

  • Can your teams speak to revenue cycle impact from your prior auth tools (e.g. FTE savings, fewer denials)? 

  • Are you positioned to partner with providers or payers pursuing WiSeR-funding or pilots?  

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Featured All-Access Insights

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Strategist | All-AccessMedStar Health-affiliated cardiology telehealth solution emerges from stealth, targeting workforce bottlenecks

Auxira Health—a virtual cardiology model initially developed and deployed by MedStar Health as part of its Connected Cardiology program—has officially launched commercially.

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Academy 360 | All-AccessCXO Partnerships for Health Equity Sustainability

Learn how to collaborate with Chief Marketing Officers, Government Relations Officers, and Philanthropy/Foundation Executives to forward health equity initiatives

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Academy 360 | Academy 360Session Breakdown | Chief Human Resources Officer Forum

Read how CHROs are dealing with policy changes from discussions at THMA's recent CHRO Forum

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Academy 360 | Academy 360Washington Update | Trump Officials Rush Reform Package

Trump officials are still aiming for final passage of the “big, beautiful bill” by the week of July 4, despite Congressional skepticism.

Podcasts

The '50/50 Rule' – and Other Unconventional AI Practices That Create Lasting Value

In this conversation, Anne Herleth discusses the critical importance of governance in healthcare AI, emphasizing the need for practical rules to manage AI effectively. She introduces four key rules: the 50-50 rule for balancing quick wins with long-term transformation, the 80% rule for choosing good enough solutions, the one-in-two-out rule for managing vendor relationships, and the 12-month rule for adapting to rapid changes in technology.

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Why (a lack of) Change Management is Holding Back Value-Based Care with Kairon Health Cofounder Nick Bartz

In this episode of the Health System CXO podcast, Robin Brand interviews Nick Bartz, co-founder and CEO of Kairon Health. This conversation covers the importance of understanding the operational realities of healthcare, the role of technology in facilitating change, and the challenges of implementing value-based care.

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Aligning on Equity: Leading Change Through Strategic Communication

In this episode, Jess Évora discusses the strategic communication necessary for healthcare leaders to advance health equity amidst changing legislation. The conversation emphasizes the importance of aligning health equity initiatives with organizational priorities, understanding stakeholder needs, and the role of influence in driving change. Jess highlights the significance of executive buy-in while cautioning against relying solely on it, and stresses the need for a robust communication strategy to effectively convey the importance of health equity in healthcare systems.

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Understanding AI's Impact on Nursing Care Delivery: Early Lessons from the Frontlines

This conversation explores the impact of AI on nursing care delivery, focusing on the challenges of nursing workload and labor costs. Anne Herleth discusses various AI pilot projects that aim to improve patient safety and nursing education, highlighting successful outcomes and the importance of nurse involvement in AI implementation.

View Episode (9min 3Sec)
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Videos

Leading Through Change: A Moderated Conversation with Trinity Health and Vituity Physician Leaders

Health system leaders are navigating unrelenting pressure—from financial headwinds to workforce instability to care delivery transformation.

In this moderated conversation, Dr. Reginald Eadie (President, Trinity Health Physician Enterprise) and Dr. Imamu "Mu" Tomlinson (CEO, Vituity) share an unfiltered look at how they are leading through disruption while positioning their organizations for long-term impact.

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Spring 2025 Chief Human Resources Officer Debrief

Gain exclusive insight into the priorities and concerns shaping the minds of leading Health System CHROs. This session distills the key themes from our closed-door Spring 2025 gatherings, providing strategic takeaways for industry partners seeking to better align with today’s health system decision-makers.

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Spring 2025 VP of Finance Debrief

Gain exclusive insight into the priorities and concerns shaping the minds of leading Health System VPFs. This session distills the key themes from our closed-door Spring 2025 gatherings, providing strategic takeaways for industry partners seeking to better align with today’s health system decision-makers.

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Spring 2025 Chief Physician Executive Circle Debrief

Gain exclusive insight into the priorities and concerns shaping the minds of leading Health System CPEs. This session distills the key themes from our closed-door Spring 2025 gatherings, providing strategic takeaways for industry partners seeking to better align with today’s health system decision-makers.

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