EvidenceCare

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Navigating Medicare Advantage: Strategies for Hospitals to Tackle Growing Challenges

EvidenceCare

Written by Carol Howard, VP of Clinical Strategy As Medicare Advantage (MA) continues to grow, hospitals have faced growing challenges in navigating complex policies, payer friction, and financial pressures. Recently, I interviewed industry experts who discussed these issues in depth during a live recording of The Better Care Podcast. The panel featured Jackie Kimmel , Senior Director of Strategy Catalyst for The Health Management Academy , Dr.

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5 Insights from Healthcare Leaders at Nashville Healthcare Sessions

EvidenceCare

In an era where healthcare leaders must balance financial sustainability with care quality, scale with personalization, and innovation with operational stability, finding the right path forward can be challenging. At the Nashville Healthcare Sessions conference , healthcare executives at the forefront of addressing these challenges shared their real-world strategies and insights.

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Determining ROI in Digital Health

EvidenceCare

Written by Amy Deaton, President and Chief Operating Officer I had the privilege of moderating a CHIME Foundation Webinar with three remarkable leaders — Dr. Zafar Chaudry of Seattle Children’s Hospital , Melanie Thomas of Nashville General Hospital , and Doug Burkott of Baptist Health Jacksonville — discussing a deceptively simple question: how do health systems define and measure ROI in digital health?

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Will New Medicaid Policies Put Hospital Margins at Risk?

EvidenceCare

Written by Carol Howard, VP of Clinical Strategy After a tough few years marked by the pandemic, staffing shortages, and rising costs, hospitals are finally starting to catch their breath. New data reveals a rebound in hospital margins, offering hope for health systems. Yet, beneath the surface of these improving numbers lies a growing concern that federal Medicaid policy could threaten the financial stability of hospitals that disproportionately serve low-income populations.

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Prior Authorization Is Changing

EvidenceCare

What Hospital UR & Revenue Cycle Teams Need to Know Written by Carol Howard, VP of Clinical Strategy A Brief History of Precertification Prior authorization (PA), originally known as precertification, began in the 1960s and expanded significantly during the rise of managed care in the 1990s. Its intended goals were to: Contain healthcare costs Limit unnecessary utilization Ensure appropriate use of high-cost services Despite these aims, PA has become an increasingly complex, fragmented, and

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Reducing Clinical Variation: A Practical Guide for Health System Leaders

EvidenceCare

Written by Dr. Brian Fengler, Co-Founder and Chief Medical Officer Clinical variation remains one of the most under-appreciated drivers of inefficiency and cost in healthcare. Behind every excess test, unnecessary admission, or prolonged length of stay lies a variation in practice—often unintentional, sometimes unavoidable, but frequently addressable.

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Engaging Physicians in Quality Improvement: Strategies for Driving Practice Change

EvidenceCare

Healthcare’s ability to continuously learn and refine practice is the backbone of safer care, stronger margins , and long-term organizational relevance. When clinical teams embed learning into daily routines, reducing clinical variation becomes achievable and practice improvement in hospitals shifts from an initiative to a habit. Physician leaders who champion this shift rely on three interconnected levers: Data-driven physician feedback that pinpoints actionable process metrics Peer comparison