Today, health plans face increasing and unprecedented challenges — from regulatory shifts to provider abrasion. Fortunately, technology and other factors are fueling new approaches that can help create new efficiencies. Implementing strategies to integrate risk and quality programs can help improve member outcomes, enhance efficiency and minimize regulatory issues. By leveraging AI and NLP, health plans can help improve transparency and automation to create a more streamlined and effective approach.
Download this white paper to learn how a digital-first, AI-powered approach can help unlock new efficiencies, empower value-based care and pave the way for interoperability.
Expert perspectives on innovation in risk and quality
Sponsored by
Optum
October 10, 2025
Discover how Optum is helping revolutionize the healthcare industry with innovative solutions in risk adjustment, quality improvement, and member engagement.
Our latest E-book, "Always Innovating: A Collection of Perspectives on Innovation in Risk and Quality," offers insights into the cutting-edge strategies and technologies helping advance risk adjustment and quality initiatives for health plans, including:
Leveraging advanced AI and machine learning to improve risk adjustment accuracy
Streamlining data acquisition and insight sharing through digital integration
Supporting better patient outcomes with more precise and efficient risk adjustment processes
Utilizing digital connections and analytics to help identify and close care gaps
Fostering a culture of continuous quality improvement with end-to-end solutions
Using advanced analytics and AI to personalize member engagement strategies
The ROI rundown: Where AI is working best in healthcare payments
Sponsored by
Waystar
September 29, 2025
AI innovations are proven to enhance efficiency, accuracy, and financial performance across the revenue cycle. But, as a healthcare leader, how do you prove its value?
In a commissioned study conducted by Forrester Consulting on behalf of Waystar, we break down the powerful results AI is delivering to maximize efficiency, enhance accuracy, and accelerate payments. Explore the current state of AI adoption across the revenue cycle, where it's delivering impact — like a 27% in denial prevention — and where leaders plan to invest next.
What’s inside
How — and where — AI is driving meaningful results across RCM
Why growing trust in AI is accelerating adoption
Where leaders are planning to expand and refine AI investments
Featuring expert perspectives from WellSpan Health and Elsevier, this eBook outlines how virtual nursing programs, mentorship opportunities, and technology integration are transforming healthcare systems to retain tenured nurses, empower new graduates, and enhance patient care.
Download now to discover how health systems are redesigning care delivery to meet the evolving needs of the nursing profession.
The 2025 Experian Health State of Claims report was based on a quantitative survey of 250 healthcare professionals responsible for financial, billing or claims management decisions. Questions were intended to determine:
The current state of claims management within provider operations
Reasons for the current state
Actions being taken [by providers] to address the challenges that exist within the claims management function
Highlights from the report include:
Increasing Denial Rates: 41% of providers say they experience a 10% or higher denial rate
Primary Denial Triggers: The top denial triggers include missing or inaccurate claim data, incomplete or incorrect patient registration data, and code inaccuracy
Staffing Challenges: 43% of respondents say they are understaffed
Role of AI in Claims Management: Many believe AI can improve the claims process, and, while few have put it to use, some are seeing promising results
Implementing and sustaining a highly effective block management process
This e-book is designed to guide organizations through the implementation of effective block management tactics.
These strategies have proven successful in improving block utilization, increasing OR efficiency and reducing overtime costs. Each tactic can be tailored to fit the unique culture and staff of your organization.
Gain access to resources for your hospital to collaborate with your OR committee and with surgeon and staff champions to improve overall block management.