Top Story
States continue to move forward with AI regulation
Illinois has banned the use of AI in mental health and therapeutic decision making without oversight from licensed clinicians under the Wellness and Oversight for Psychological Resources Act, which allows AI for administrative support and aims to protect patients from unregulated AI and preserve jobs for professionals. Other states, including Nevada and Utah, have enacted similar laws, while others are considering legislation to regulate AI in behavioral health care and patient communications.
Learn About the IOTA Model and Kidney Transplant Admission Reimbursements
The newly introduced Increasing Organ Transplant Access (IOTA) Model aims to increase access to kidney transplant and streamline care for fee-for-service (FFS) enrollees. Join us to learn more about the IOTA model and FFS kidney transplant admission reimbursements.

MAT-US-2509352-v1.0-08/2025
ADVERTISEMENT:

Providers & Suppliers
Bad debt, expenses undercut gains in per-patient revenue
Hospital margins improved from 1.9% in May to 3.7% in June, according to a Kaufman Hall report based on data from 1,300 hospitals. Per-patient and outpatient revenue rose, but nonlabor expenses and bad debt also rose, undercutting gains. Kaufman Hall Managing Director Erik Swanson says small hospitals should ensure they accurately capture all owed revenue and focus on day-to-day operations.
Close the Statin Gap
Many MA members with diabetes are not receiving or adhering to statin therapy—leading to worse outcomes. See how an integrated pilot improved adherence, reduced risk, and plan performance using a proactive, data-backed approach. Read the case study.
ADVERTISEMENT:

Medical Update
Study supports controlling BP to below 120 systolic
A study in the Annals of Internal Medicine found that keeping blood pressure to below 120 systolic may be more protective against heart attacks, strokes, heart failure and other cardiac problems than using higher target levels. The strategy also was linked to only a small increase in the cost of treatments.
Proactive functional health is the future of geriatric care
Five older adults practice tai chi outdoors
(FatCamera/Getty Images)
Early assessments of functional and cognitive health in aging patients help identify risk factors and enable person-centered care plans to maintain mobility, strength, balance and cognitive function, writes geriatrician Kanramon (Kara) Watthanasuntorn, medical director of the Center for Better Aging in Chicago. Watthanasuntorn presents the holistic "4Ms framework" to guide geriatric care plans, and notes that clinicians can incorporate quick, simple assessment tools into existing workflows.
Vaccine Integrity Project finds no major safety issues in review
The Vaccine Integrity Project at the Center for Infectious Disease Research and Policy has released a comprehensive review affirming the safety and efficacy of influenza, respiratory syncytial virus and COVID-19 vaccines. The review's findings support the American Academy of Pediatrics' recommendation for COVID-19 vaccination for children ages 6 months to 23 months and for those ages 2 to 18 who are in certain risk categories.
Why wait to recover only 10–40% post–pay?
Our cutting–edge, real–time fraud detection and payment integrity solution analyzes claims instantly, identifying suspicious activity before payments are made. Backed by industry experts and advanced AI, PreShield helps you reduce losses, improve efficiency and protect your bottom line. Let's talk!
ADVERTISEMENT:

Emerging Trends: Social Determinants of Health
Back-to-school asthma ED visits higher in vulnerable areas
Children living in areas with high social vulnerability have a higher risk of asthma-related emergency department visits when school starts, according to a study in The Journal of Allergy and Clinical Immunology. Factors such as crowded classrooms and limited access to health care exacerbate the risks.
Phone support intervention reduces BMI in preschoolers
A two-year, nurse-led phone intervention was associated with significant reductions in BMI in preschool children, especially those from lower-income families, according to a study in the International Journal of Obesity. The program, which included support calls and text messages, led to better dietary habits and less screen time.
Sleep apnea risk higher during the weekend
A hand holds a lit cigarette beside an ashtray and a mug of beer atop a bar.
(SimpleImages/Getty Images)
Weekend social activities that include drinking and smoking may contribute to a spike in sleep apnea, according to a study in the American Journal of Respiratory and Critical Care Medicine. Researchers found a 24% increased risk of sleep apnea in adults under 60 on weekends, and an 18% increase overall. Factors such as alcohol use, lighter sleep and inconsistent use of sleep apnea therapies may play a role, researchers said.

Health Plan Company News

Solutions Provider News

The Most-clicked Stories in Yesterday's Newsletter Were ...