April has seen a slew of executive hires, promotions and layoffs across the healthcare industry. For instance, Aledade, Humana and Zimmer Biomet named new executives. There were also layoffs at organizations including Baylor Scott & White Health Plan, Novo Nordisk and UnityPoint Health.

The post Healthcare Moves: A Monthly Summary of Hires, Exits and Layoffs appeared first on MedCity News.

In this episode, we’re joined by Meghan Doyle, CEO of Partum Health. We discuss the company’s new partnership that offers 24/7 access to doula support at University of Chicago Medicine Family Birth Center – Hyde Park.

The post MedCity FemFwd: Inside Partum Health’s Partnership with UChicago Medicine appeared first on MedCity News.

The first major update to HIPAA in more than a decade will eliminate the distinction between “required” and “addressable” safeguards, making key cybersecurity and physical security measures mandatory for all healthcare providers. This shift will expose gaps in hospitals’ fragmented security systems, though, according to Kumar Sokka, CEO of cybersecurity platform Acre Security.

The post Why Some Hospitals Won’t Be Able to Comply With Upcoming HIPAA Updates appeared first on MedCity News.

Financial assistance is moving from discretionary policy to regulated infrastructure. For health systems, that shift has significant operational and financial implications.

The post Financial Assistance Reform Is Reshaping Revenue Cycle Strategy appeared first on MedCity News.

Medtronic suffered a cyberattack on its corporate IT systems. The incident highlights growing cybersecurity risks in the medtech sector, with cybergangs increasingly using phishing and other human-engineering tactics to gain access to data.

The post 6 Things to Know About Medtronic’s Cyberattack appeared first on MedCity News.

Many health plans are discovering that even after digitizing medical policies and implementing FHIR APIs, prior authorization turnaround times remain slow and provider frustration remains high. The reason is straightforward: digitization alone does not make medical‑necessity determinations executable by automated systems at scale.

The post Digitizing Medical Policy Alone Will Not Automate Prior Authorization at Scale appeared first on MedCity News.

Nvidia and Hoppr are betting that healthcare AI will scale not through standalone applications, but through a new infrastructure layer that lets providers develop and deploy their own imaging models.

The post Why Healthcare AI Still Can’t Scale — and How Nvidia & Hoppr Are Trying to Fix It appeared first on MedCity News.

Ed Park is sincere and passionate about his calling as the CEO of Devoted Health, which provides Medicare Advantage plans to seniors in 29 states. But it remains to be seen if he can do more or the same with less.

The post CEO of For-Profit MA Plan Tells CMS “Pay Us Less” appeared first on MedCity News.

As patients take to social media, in all its ungated glory and promotion of misinformation, how can they be certain that what they are getting is accurate? What voices can they trust?

The post Patients are Turning to HCP Influencers in the Age of AI and Misinformation appeared first on MedCity News.

Midstream Health is taking a bit of a different approach to healthcare AI by focusing on reducing hospitals’ costs rather than boosting their revenue. The startup uses AI to identify savings opportunities across fragmented spending data, which helps health systems like Mount Sinai and CommonSpirit quickly improve their purchasing decisions.

The post Why Some Hospitals Are Betting on Midstream Health to Help Eliminate Waste appeared first on MedCity News.

The American Medical Association is urging Congress to add safeguards for AI mental health chatbots amid safety concerns, while noting their potential to expand access.

The post AMA Calls on Congress to Improve Safeguards for AI Mental Health Chatbots appeared first on MedCity News.

Amperos Health’s Series A round was led by Bessemer Venture Partners, with participation from Uncork Capital and Neo.

The post Startup Helping Providers Manage Denied Claims Raises $16M appeared first on MedCity News.

Telehealth clinic Hone Health partnered with imaging company BodySpec to give its patients access to DEXA body composition scans. The partnership seeks to help providers and patients on GLP-1s distinguish fat loss from muscle loss and better evaluate how these drugs are affecting the body.

The post Beyond the Scale: How Imaging Can Help Determine GLP-1 Efficacy appeared first on MedCity News.

[Sponsored] In this episode, MedCity News’ Arundhati Parmar chats with a pharmacy benefits leader and a virtual pharmacy operator about ways to modernize and scale prior authorization.

The post MedCity Pivot Podcast: Modernizing Prior Auth appeared first on MedCity News.

Healthcare has solved for the hard part. The science, the surgery, the diagnosis: by global standards, we’re exceptional.
What we haven’t solved for is what happens when the patient goes home.

The post The Healthcare Industry Has a Last Mile Problem — It Hasn’t Realized It Yet appeared first on MedCity News.

A consultant who has analyzed healthcare policy over many decades declares that MA is in the middle of a fundamental reset both in terms of market headwinds and federal scrutiny.

The post Policy Expert Believes CMS is Taking “Adversial Posture” to Medicare Advantage appeared first on MedCity News.

When patients disengage, preventive care is missed, chronic conditions worsen, care shifts to higher-cost settings such as the emergency department and urgent care, and patients fragment across systems, reducing continuity.

The post Stopping Patient Attrition Before it Starts: A Proactive Approach to Healthcare Marketing appeared first on MedCity News.

CMS is proposing to make its joint replacement bundled payment model mandatory nationwide. Experts say it is a logical step, but warn that mandatory participation could be challenging for hospitals to implement.

The post Expanding the CJR Model Is a Logical Step in VBC, but Implementation Challenges Remain appeared first on MedCity News.

CMS is rolling out its health tech ecosystem initiative with a new Medicare app library that functions like a healthcare “App Store,” aiming to make patient data more portable and accessible across vetted digital health apps.

The post CMS’ New ‘App Store’ Is Trying to Turn Interoperability Into a Digital Health Distribution System appeared first on MedCity News.

Innovaccer is committing $250 million to expand its AI agent platform, which automates workflows across areas like prior authorization, revenue cycle management and population health. The move comes amid an ongoing debate over whether administrative AI tools can ultimately reduce costs for providers.

The post Why Innovaccer Is Pouring $250M into Its Agentic AI Platform appeared first on MedCity News.

Hospitals are still on quite fragile financial footing if you look beneath the surface, according to new Kaufman Hall data. Rising costs, uneven patient volumes, and ongoing reimbursement and payer mix pressures continue to limit the sector’s financial recovery.

The post Hospital Margins Squeeze as Costs Outpace Revenue Growth appeared first on MedCity News.

The patient’s voice should be an entry point and not a barrier to better compliance and health outcomes. A nurse practitioner outlines a protocol for a frank exam-room exchange that sustains cultural humility.

The post Trust Before Triage: Why I Let the Patient Help Write the Agenda appeared first on MedCity News.

The Department of Justice has sued both OhioHealth and NewYork-Presbyterian Hospital this year, alleging that they use contracting tactics that limit competition and keep healthcare prices high. The cases mark a broader push by regulators to scrutinize how health systems use “all-or-nothing” contracts to shape insurance networks and patient access.

The post Inside The DOJ’s Hospital Contracting Crackdown: What Message Are the Feds Sending? appeared first on MedCity News.

With data from open enrollment now coming in, we no longer need to rely on guesswork. Let’s take stock of where the ACA Marketplace stands today and what it means for our healthcare system.

The post ACA Stress Test: Four Key Takeaways from This Year’s Open Enrollment appeared first on MedCity News.

The Social Security Administration’s move onto the TEFCA interoperability framework is beginning to streamline disability determinations by enabling faster exchange of medical records from hospitals. Dr. David Kaelber, chief health informatics officer at MetroHealth System in Ohio, said the shift is replacing a months-long, fax-driven process with near real-time data sharing.

The post How TEFCA Is Speeding Up Disability Benefits Determinations at Hospitals appeared first on MedCity News.

The good news: fixing our ancient administrative infrastructure does not require technology that’s particularly experimental, nor does it require passing new laws or regulations. It does, however, require coordination.

The post Healthcare’s Most Fixable Cost Problem: Administrative Waste appeared first on MedCity News.

Luminai raised $38 million in Series B funding to scale its AI platform that automates healthcare administrative workflows. The company is working with Cleveland Clinic to expand the use of its system across high-volume processes, starting with referral management.

The post Luminai Raises $38M With Cleveland Clinic Using Its AI for Hospital Operations appeared first on MedCity News.

This is not a debate about care models or physician preferences. It is a contest over who will control the referral pathways and the revenue streams that originate at the front door of healthcare.

The post The Quiet Battle for the Front Door of Healthcare appeared first on MedCity News.

Jefferson Health in Philadelphia is suing Aetna over a new Medicare Advantage payment policy that hospitals say unfairly reduces reimbursements for legitimate inpatient stays. The case highlights a broader clash between providers and Medicare Advantage plans over “downcoding” short hospital stays and controlling costs.

The post Jefferson Health Sues Aetna As Providers’ Frustration with MA Grows appeared first on MedCity News.

[Sponsored] Enterprise EHR boosts scalability, interoperability, and governance for large healthcare systems.

The post The Power Behind Enterprise EHR Software for Large Healthcare Systems  appeared first on MedCity News.