The CMS is working with insurers to prevent misuse of prior authorization in Medicare Advantage, while at the same time the CMS Innovation Center is launching the WISeR model to test the use of prior authorization in conventional Medicare, using AI to find signs of fraud, waste and abuse. Attorney Jeff Wurzburg said the demonstration model could blur the lines between Medicare and Medicare Advantage and lead to changes in prior authorization management. "I anticipate frustrated [health care] providers and beneficiaries who are not used to prior authorization in such a fashion under traditional Medicare," Wurzburg said.

New Medicaid funding and eligibility policies may decrease the number of enrollees, increase the number of uninsured people and take a toll on hospital finances, putting additional pressure on clinical documentation integrity professionals, writes certified documentation integrity practitioner Cheryl Ericson. CDI departments may need to expand their review populations to include Medicaid and uninsured patients, even as financial pressures mount.

Giving patients immediate access to their medical test results can empower patients and prevent the anxiety of anticipating medical results, but it can also cause confusion and anxiety if test results are misunderstood. Some clinicians have hidden or delayed access to reports that could mislead patients in the absence of context. The practice may prevent needless worry, but it may also be seen as paternalistic.

Epic Systems' new MyChart Central will enable patients to link multiple MyChart patient portals into one website and use a mobile app to access their information. Epic has also introduced Epic ID, a single login for consolidated MyChart Central accounts.

Generative AI can improve workers' creativity, but only when employees using it actively analyze their tasks, think about the problems they are trying to solve and adjust their approaches so AI can support their goals, according to a study in the Journal of Applied Psychology. Companies should invest in training to help employees actively engage with AI, says Shuhua Sun, a business professor at Tulane University. "Even the most advanced generative AI systems won't enhance creativity if employees are passive consumers of their output and lack the metacognitive strategies needed to engage with them effectively," Sun said.

A report by MIT's Project NANDA highlights a "shadow AI economy" in which employees use personal AI tools like ChatGPT and Claude for work, often without the knowledge of the company's IT department. Researchers found that although only 40% of companies have official AI tool subscriptions, employees at 90% of companies use personal AI tools for work. They also found that 95% of organizations that have invested in generative AI report that it has had no impact on profits.

A settlement valued at $2.8 billion between Blue Cross Blue Shield and up to 3 million health care providers has been approved by a federal judge, settling allegations that the insurer underpaid reimbursements. The agreement requires BCBS to make changes to spur market competition, including building a cloud-based claims verification and tracking platform.