Member engagement is the upstream fix for Star Ratings, risk adjustment, and total cost of care
With the 2027 Star Ratings now released, we’re reviewing the results and what they mean for the market. We’re also in the midst of the last quarter before the program redesign hits, as CMS is taking the program in a different direction in January.
What happens when a health plan shows up before the ER visit?
Nearly $500 in annual employer savings per member, and a double-digit drop in ER visits, from one health plan’s virtual-first program
Why your gap lists won’t survive the new Star Ratings math
CMS narrowed the Medicare Advantage Star Ratings measure set, removing 11 measures focused on administrative process and adding a clinical measure focused on depression screening beginning with the 2027 measurement year.
Imagine the headline: What happens when healthcare AI makes the call without clinical review?
From a self-driving car accident to an algorithm allegedly overriding physicians, the AI failures making headlines share one root cause: nobody was positioned to stop them in time.
Invest in outcomes, not usage: why token efficiency matters in healthcare AI
AI token spend is growing faster than most finance teams expected, and health systems are already feeling it. Here’s what the data and healthcare leaders are saying about getting AI efficiency and tokenomics right.
Healthcare AI governance lives in the workflow, not the policy binder
Pager Health builds AI governance as a platform: five guardrails, human-in-the-loop design, and full audit trails for every clinical interaction
3 key gaps in healthcare navigation that spike costs
Most healthcare navigation platforms skip the clinical decisions that prevent avoidable costs. See the three decision points most vendors overlook and why they matter.
Four things AI appointment scheduling must do for healthcare payers
Discover the four critical requirements for AI appointment scheduling in healthcare and why orchestration beats basic booking tools for payers.
Agentic AI in healthcare is too big for most to build alone
Discover the hidden reason agentic AI in healthcare fails at scale (and the smarter alternative payers are switching to).
The pros and cons of AI in healthcare
AI is changing how payers handle provider search and scheduling. The benefits are huge, but so are the risks if AI is deployed without proper governance. Here’s what health plans need to know before investing in AI-powered navigation.
From cost center to value driver: AI-enabled nurse line services
Triage alone isn’t enough members need guidance beyond the call. AI-powered nurse line services extend into care navigation, directing patients to the right care at the right time. This shift transforms a cost center into a measurable value driver with real ROI.
Digital value at scale: How blues plans can improve ROI with AI
Health plans have invested heavily in digital health, but measurable ROI remains challenging. At the Consortium Health Plans Sales Advantage conference, leaders discussed how AI-driven orchestration can simplify care navigation and improve engagement.
Red-Teaming Healthcare AI: A Framework for Responsible GenAI Deployment at Scale
Healthcare AI operates in high-stakes environments where every response can influence patient decisions, trust, and outcomes, requiring a fundamentally different approach to GenAI deployment.
Personalized Behavioral Health Care with AI: The Future of Tailored Navigation
AI-powered behavioral health navigation is transforming fragmented care into a seamless, personalized experience that guides members to the right support, when and where they need it most.
ROI First, VOI Next: Helping Health Plans Deliver What Employers Really Want
Health plans that prioritize delivering real Value on Investment through simplified, integrated, and customizable solutions can help employers reduce costs, improve outcomes, and engage employees, laying the groundwork to prove measurable ROI in today’s complex benefits landscape.
AI Agents in Action: Revolutionizing Navigation by Driving Personalized Care and Trust
This on-demand webinar showcases how agentic AI is reshaping care navigation by combining real‑time personalization and clinical support to build member trust and streamline access from triage to provider search, benefits, and care coordination.
Moving Beyond the Cost Pyramid
It's time to move beyond the outdated cost pyramid model and focus on integrated, intelligent navigation that reduces systemic waste, improves outcomes, and delivers value across the entire member population and not just the highest-cost segments.
Member-Centered Navigation Powered by AI: The New Competitive Edge
Explore how health plans can turn poor member experience into a strategic advantage by delivering personalized, seamless, and AI-powered support that today’s consumers expect.