With the passage of OBBBA in July 2025, the landscape has shifted for Enhanced Direct Enrollment, the streamlined tech-enabled enrollment solution. EDE hasn’t been repealed, but the environment in which it operates could limit its reach and effectiveness.
Precision UM reduces provider burden and abrasion, enhances member satisfaction, and decreased effort and costs in managing the authorization process. Learn more.
Discover how integrating prior authorization with payment integrity fosters transparency, prevents denials, and builds trust between payers and providers.
Explore how automation, analytics, and hybrid payment models drive accuracy, reduce overpayments, and enhance payer efficiency in healthcare.
By Chris Shiffert The impending policy shifts from the “One Big Beautiful Bill Act” (OBBBA or H.R.1) put Medicare Advantage (MA) plans in a unique and enviable position when it […]
Learn why the unauthorized deployment and use of AI tools by teams or individuals who don’t get a green light go-ahead from IT or security departments harms healthcare.
Payers and providers face new financial realities under the One Big Beautiful Bill Act (OBBBA). Learn how to optimize healthcare operations.
Discover how Sagility’s end-to-end expertise transforms healthcare operations with AI, analytics, and clinical intelligence.
Discover how healthcare consulting drives aging-in-place success by improving coordination, outcomes, and stakeholder experience
Payers deny nearly 15% of all claims they receive—including many that were pre-approved—only to have 54% of them overturned after lengthy and costly provider appeals. To make matters worse, the cost to providers nationwide to appeal decisions is approximately $262 billion every year.
Sagility Nurse Assist uses GenAI, Agentic AI, and clinical intelligence to streamline utilization management, prior authorization, and care delivery.
By Sohail Djariri, Chief Growth Officer, Sagility At Sagility, we often talk about smarter healthcare business solutions—and recently, the industry has taken note. I’m proud to share that Sagility has […]
By Alan Vitale and Don Searing Healthcare payers struggle with unstructured data (clinical notes, faxes, handwritten forms), which makes up over 80% of healthcare information. This data, unlike organized claims […]
Preventable rehospitalizations remain a critical concern for senior care organizations, impacting both operational efficiency and resident outcomes. Readmissions drive up healthcare costs, disrupt continuity of care, and often signal deeper […]
By Krithika Srivats, Senior Vice President of Clinical Practice at Sagility In today’s rapidly evolving healthcare landscape, hospitals and physician groups face mounting challenges from clinical and coding denials. While […]
By Abhishek Danturti In the world of healthcare, payer contact centers are the nerve center of customer service. From answering billing questions to navigating the labyrinth of insurance benefits, these […]
By Sohail Djariri The AHIP 2025 conference brought forward groundbreaking insights that will reshape the future of healthcare for stakeholders. Whether you see yourself as a payer, provider, member, or […]
By Sohail Djariri Creating an empathetic, holistic health plan member experience can drive improved engagement and help resolve the challenges often associated with healthcare. While resolving healthcare issues is critical […]
By Sohail Djariri Identifying and mitigating frailty in older adult health plan populations through an aging-in-place-as-a-service solution can help health plans holistically approach this challenging issue in the member population. […]
By Sohail Djariri There are many communication systems and strategies available to healthcare organizations today, yet there remains a significant disconnect between those same organizations and their members. Ongoing distractions […]
Healthcare organizations face tight budgets, a continued need to increase productivity, lower costs, enhance technology, and reinforce IT infrastructure all while continuing to improve the healthcare consumer experience. While building […]
By Titus Leo and Jason Besterfeldt As today’s hospital margins are increasingly in the red, and health systems are asked to do more with less, all eyes are on cost […]
