Saturday, November 7, 2026

< + > Weekly Roundup – November 7, 2026

Welcome to our Healthcare IT Today Weekly Roundup. Each week, we’ll be providing a look back at the articles we posted and why they’re important to the healthcare IT community. We hope this gives you a chance to catch up on anything you may have missed during the week.

What’s Next for eHealth Exchange? President and Executive Director Doug Dietzman sat down with John Lynn to outline the organization’s priorities for 2027: Engage with payers, expand beyond treatment-focused exchange, and strengthen relationships with federal partners. Read more…

Using Ambient AI to Reduce Physician Burden. SVP and CIO Mark Galea at Louisiana’s Willis Knighton Health, plus Commure’s Ian Shakil, got together with John to describe the importance of finding a vendor with a mature solution and a willingness to partner, not just one with EHR integrations. Read more…

How Virginia’s Augusta Health Automated Document Routing. CIO Leigh Williams, along with Audrey Brislin at Forward Advantage, talked to John about replacing digitized document routing with automation for use cases that are consistent and predictable – and boring. Read more… 

Advancing Healthcare AI Governance and Patient Identity Management. John summarized his day at Rhapsody Connect; highlights included doing identity management at scale, training AI on clean data, governing APIs, and supporting information exchange. Read more…

A Look at Workday’s ERP in Healthcare. John sat down with Keith Lohkamp to talk about Workday’s role helping health systems manage the business operations that ultimately support patient care. It starts with connecting clinical and operational data. Read more…

East Georgia Healthcare Center Discusses eClinicalWorks’ Pharmacy Solution and AI. COO Peyton Frye connected with John and chatted about bringing new pharmacy operation capabilities and AI tools into existing workflows and synchronizing data across applications. Read more…

Oracle Previews an Intent-Driven EHR Strategy. SVP and Chief Medical Officer Bharat Sutariya sat down with Colin Hung to talk about how to deliver next-generation clinical intelligence without forcing health systems into another painful data migration. Read more…

Life Sciences Today Podcast: Earlier Than Early Breast Cancer Detection. Danny Lieberman talked to Sivan Sadan at Pink Star Technologies about meeting strict U.S. privacy requirements to implement early screening of breast MRI. Read more…

CIO Podcast: Reliability in AI Adoption. Data scientist Renu Sara Nargund at UT MD Anderson Cancer Center joined John to discuss why “human in the loop” isn’t enough to solve the reliability problem with AI, especially in oncology. Read more…

Today’s ACO Technology May Not Be Enough for What’s Coming. ACOs now have a much bigger charge to manage specialty care and adopt CMS tools to negotiate rates. To support that, Theresa Hush at Roji Health Intelligence outlined sikx essential layers of value-based care technology. Read more…

Provider Enrollment: A Data Problem Hiding in the Denial Queue. Sooner is better for reconciling provider records, Madison Gardner at AMS Solutions said. Information can exist in multiple locations, and claims can fail even when EHRs and clearinghouses work exactly as designed. Read more…

Automation and AI Are Quietly Rebuilding the Hospital Back Office. Since the back office is data-rich, highly repetitive, and directly connected to financial performance, Paige Schwein at Healthrise said it offers a clear opportunity for effective AI adoption. Read more…

The Hidden Risks of Using Personal Cell Phones for Patient Communication. While HIPAA doesn’t prohibit the use of personal devices, the compliance question is whether an organization protects ePHI that the device creates, receives, stores, or transmits, noted Pankaj Gupta at iPlum. Read more…

Clinical AI Needs Version Control, Not Just Validation. Because AI tools can be updated far more frequently than traditional clinical technology, AI researcher Dr. Michael T. Neely said it’s critical for organizations to keep close tabs on how changes to clinical AI tools may impact performance, risk, or workflow. Read more…

This Week’s Health IT Jobs for November 4, 2026: Arkansas-based Forrest City Medical Center is looking for a CEO; so is Illinois-based Olympia Fields Hospital. Read more…

Bonus Features for November 1, 2026: 91% of patients want their permission required when AI is used for diagnosis; plus, 64% of providers plan to deploy AI for claims and denials management. Read more…

Funding and M&A Activity:

Thanks for reading and be sure to check out our latest Healthcare IT Today Weekly Roundups.



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Friday, November 6, 2026

< + > Health System Zombie, Treatment Coverage, and General Medicine – Fun Friday

Happy Friday everyone! You made it through another great week. We hope you have accomplished all you wanted and are ready for a great weekend. That means it’s time for another edition of Fun Friday where we try to make you smile as you head into the weekend.

This felt like an appropriate one for Halloween. Does anyone else feel like this looks like the healthcare system? The only thing I’d add is a lot more than 2 people or groups are pulling at it.

I probably shouldn’t laugh at this one, but I did. Sometimes coverage feels this way.

This one is so dumb it’s funny. There’s an interesting balance in healthcare between specialist and generalist.

That’s all for this week. We hope you enjoyed and that you’ll tune in next week for some more great health IT content.



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< + > Earlier Than Early Breast Cancer Detection – Life Sciences Today Podcast Episode 86

We’re excited to be back for another episode of the Life Sciences Today Podcast by Healthcare IT Today. My guest today is Sivan Sadan, Co-Founder and CEO at Pink Star Technologies. In this episode, I sit down with Sadan to talk about how Pink Star is making breast cancer detection earlier than early.

Check out the main topics of discussion for this episode of the Life Sciences Today podcast:

  • Tell us about your journey to Pink Star. How did you end up doing an AI startup for early screening of breast MRI?
  • How do you create value?
  • Who are your customers?
  • Who pays you, and how do you plan to charge people for using your system?
  • What’s your superpower? What’s your moat?
  • US privacy requirements are tough, so how did you get passed by Mount Sinai with this?
  • Breast cancer is known to be sensitive to race and ethnicity. How does that influence your AI model?
  • What are three things you want to do for your customers in the next twelve months?
  • What is the biggest anti-pattern in your industry?
  • What is the closest you’ve come to a surprise that would have cost you the company?
  • How many salespeople do you have?

Subscribe to Danny’s newsletter to get strategic patterns for life science leaders building a defensible business.

Be sure to subscribe to the Life Sciences Today Podcast on your favorite podcasting platform:

Along with the popular podcasting platforms above, you can Subscribe to Healthcare IT Today on YouTube.  Plus, all of the audio and video versions will be made available to stream on Healthcare IT Today. As a former pharma-tech founder who bootstrapped to exit, I now help TechBio and digital health CEOs grow revenue—by solving the tech, team, and go-to-market problems that stall your progress. If you want a warrior by your side, connect with me on LinkedIn.

If you work in Life Sciences IT, we’d love to hear where you agree and/or disagree with our takes on health IT innovation in life sciences. Feel free to share your thoughts and perspectives in the comments of this post, in the YouTube comments, or privately on our Contact Us page. Let us know what you think of the podcast and if you have any ideas for future episodes.

Thanks so much for listening!



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< + > The ACO Technology You Have Today May Not Be Enough for What’s Coming

The following is a guest article by Theresa Hush, Co-Founder and CEO at Roji Health Intelligence

The value-based care world—for which your ACO was built—has greatly altered. ACOs now have a much bigger charge to manage specialty care for their patients and to adopt CMS tools to negotiate rates with high-performance networks. The TEAM payment model is live, and ACOs have a role. ASM arrives in 2027 with more ACO investment. LEAD will reshape the ACO model for the next decade. Ahead lies a deeper role in care management, quality outcomes, and coordinated care across all types of providers, not just ACO participating providers. The same high-risk primary care patient sitting in your ACO panel is very likely the same person walking into a TEAM surgery or an ASM episode.

This new reality demands better technology. But here’s the honest truth: Many ACOs have no platform now and are still working their services from claims data with no aggregated data to back it up. Further, most value-based care platforms are not yet organized to handle all the functions your ACO will need.

Don’t lose time researching the ultimate system. Begin a process now that will enable your ACO to meet this central need: a unified hub for value-based care that can draw from every relevant data source to give your team a single coherent view of each patient, then support the interventions for that patient in each episodic or condition-based payment model. You need to be building toward that hub and evaluating your current tools against those needs if your ACO is to be at the center of your value-based care ecosystem.

The Essential Layers of Your VBC Technology

1. Your Foundation: A Central Database to Integrate Data from EHRs, Claims, Finance, Population Health, Episode Analytics, and Risk Adjustment Algorithms

Many ACOs discovered shortfalls in their data mastery during implementation of APP Reporting; they struggled to aggregate clinical data from diverse EHR systems across a heterogeneous practice mix. Some resorted to Medicare CQMs or chose eCQMs to avoid data hassles, but in the end both strategies wasted their data resources. As CMS moves to FHIR-based digital quality measures, your platform must have a credible, specific path toward FHIR adoption and seek deep clinical data. 

2. A Bifocal Lens on Total Cost of Care and Episodic Analytics

Patients most at risk in your ACO panel are likely those heading into a TEAM surgery or an ASM episode. A patient with uncontrolled hypertension, Type 2 diabetes, and coronary artery disease doesn’t stop being your ACO’s responsibility the moment a surgeon schedules a CABG. In fact, that’s exactly when your ACO’s role becomes most critical—and most financially consequential. The comorbidity burden in CABG patients is high, the complication rates are significant, and the opportunity for pre-surgical intervention to prevent complications is real.

This is precisely where ERAS (Enhanced Recovery After Surgery) protocols are so powerful and so underused. Hospital adoption has been slow because ERAS is operationally difficult without the right infrastructure. But your ACO, with visibility into a patient’s longitudinal primary care record, is uniquely positioned to facilitate that process. When should an ACO begin preparation for a TEAM surgery? It must be long before the surgical date, so you can hand a better-prepared patient to the surgical team. Validating patient conditions and pre-treatment of patient risks improves outcomes and reduces episodic costs. Your technology must be able to support this kind of coordinated view, spanning primary care, specialty care, and the episode window, without losing the patient in a hand-off between disconnected systems. 

3. Quality Reporting That Keeps Pace With CMS—Easily

Quality performance is not a compliance activity, but a direct multiplier on shared savings. APP Plus measures will grow, and MIPS Value Pathways are expanding to new specialties and may become mandatory. ASM will bring its own quality requirements in 2027. Your hub must keep pace with this trajectory automatically, not as a special project every fall when CMS releases a new final rule.

4. Post-Acute Care Visibility—Close the Black Hole

Post-acute care is an expensive and often poorly managed transition point in both Total Cost of Care models and TEAM episodic payments. For lower extremity joint replacements—the highest-volume TEAM procedure—the difference between a well-managed SNF referral and a poorly chosen one can mean days of unnecessary skilled nursing care, avoidable readmissions, and thousands of dollars in episode cost overruns. Your ACO and your TEAM hospital share a vested interest in solving this together. Your technology hub must be able to show you post-acute utilization patterns by facility, by referral source, and by episode type—so that you can build a preferred network based on performance data, not habit. Right now, many ACOs are flying blind on post-acute.

5. Specialty Network Intelligence for the LEAD Era

LEAD’s CMS-Administered Risk Arrangements (CARA) create a formal mechanism for ACOs to enter episode-based risk sharing with specialist groups. This is new territory, and the data requirements are genuinely different from what ACOs have managed before. To make CARA work, your ACO needs to be able to profile specialists by cost and quality performance across episode types, identify which specialty referral patterns are driving cost variation in your attributed population, and model what a preferred specialist network would do to your performance. These are not capabilities most ACO platforms were built for. But they are capabilities your hub must develop—because specialty costs are where the next generation of ACO savings will be won or lost.

6. Patient-Centric Care Management and Interventions

The components above are focused primarily on succeeding in payment models, or the ACO and its providers. But key ACO functions for patients, like improvement plans, specialty referral management, care management, and population health, are among the top reasons that ACOs need the functionalities that key clinical and other data provide. Interventions, for example, that are identified for patients in advance of a TEAM surgery or coming out of a condition-based episode, must be undertaken on a patient level, not a disease level. The ultimate purpose of a value-based care technology is to improve the patient’s status and his or her risks. Thus, the technology must be able to provide a window not only on all the data, payment models, and costs associated with an individual patient, but also to deploy corrective actions for that patient. Especially interventions, pre-surgical programs, and chronic disease management programs must be patient- and not disease-centric, so that the intervening providers— population health team, clinicians, health coaches, registered dietitians, and so on—have an organized plan for each patient.

No one expects your technology to do all this perfectly today. The payment models are new, the data standards are still evolving, and even the most sophisticated VBC platforms are building toward this vision, but have not yet fully arrived. But the vision itself is not optional. An ACO that is still evaluating technology purely by its claims analytics capability, or its quality reporting module in isolation, is asking the wrong questions in 2026.

The right question to ask: Does this platform have the architecture and the roadmap to become the central hub your ACO needs—connecting primary care data, specialty episode data, quality reporting, post-acute performance, and financial reconciliation into a single, coherent view of every patient? If the answer is yes, you have a foundation worth building on. If the answer is uncertain or evasive, that uncertainty will compound with every new payment model CMS introduces.

About Theresa Hush

Co-Founder and CEO at Roji Health Intelligence, Theresa Hush is a health care strategist and change expert with experience across the health care spectrum, including public, non-profit, and private sectors.



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< + > Midstream Health Raises $20M Series A | nPhase Secures $30 Million in Series D Funding

Check out today’s featured companies who have recently raised a round of funding, and be sure to check out the full list of past healthcare IT fundings.

Midstream Health Raises $20M Series A to Strengthen the Financial Sustainability of America’s Health Systems

AI Platform Now Optimizes Financial Decision-Making Across Health Systems Representing More Than $100 Billion in Annual Operating Expenses and 250 Hospitals

Midstream Health, the autonomous financial operations platform for health systems, today announced a $20 million Series A as it expands across a customer network representing more than $100 billion in annual operating expenses and over 250 hospitals nationwide. Midstream helps these institutions find and recover margin across both revenue and cost, strengthening the financial capacity required to continue investing in care and serving their communities.

The financing round was led by Valtruis with continued participation from Andreessen Horowitz (a16z), Foundry, and CommonSpirit Ventures, bringing Midstream’s total funding to $29.2 million. Fairview Health Services and Keck Medicine of USC are among the newest health systems to join the platform, alongside CommonSpirit Health, Mount Sinai Health System and Houston Methodist.

This announcement comes as health systems are facing a financial sustainability crisis, fighting to protect razor-thin margins. More than 110 rural hospitals have closed over the past 20 years, and another 720 — representing roughly a third of all rural hospitals — are at risk of closure. Much of what’s slipping away is money health systems have already earned, buried in their own contracts and spend. Recovering that margin is about more than improving the bottom line; it gives health systems greater capacity to invest in care, serve their communities, and deliver on the mission their patients depend on.

“In this environment, health systems need solutions that can improve their financial position quickly,” said Mike Spadafore, Managing Director of Valtruis…

Full release here, originally announced October 29th, 2026.

nPhase Secures $30 Million in Series D Funding to Drive Global Expansion of AI-Native Clinical Data Platform for Life Sciences

Investment Will Scale nPhase’s Enterprise Clinical Data Business and Accelerate Expansion of Its Statistical Computing Environment (SCE), Unified Data Management System (UDMS), and Agentic AI Capabilities Across the Clinical Data Lifecycle

nPhase, Inc., today announced the closing of a $30 million Series D funding round led by Viking Global Investors to accelerate the company’s AI-native clinical data platform for pharmaceutical sponsors seeking to unlock the full potential of their data and power AI at scale. Viking Global Investors is an investment firm managing more than $54 billion in capital across public and private investments. The financing represents nPhase’s first equity capital raise since 2017, reflecting the company’s disciplined approach to capital management and its ability to build and expand its business without additional equity financing for nearly a decade.

“We see a significant opportunity to modernize how the life sciences industry manages and uses clinical data,” said Levi Malik, a Principal at Viking Global Investors. “nPhase combines something rare in the AI market: an established foundation in clinical research, deep understanding of regulatory requirements, and a clear vision for enterprise-scale AI. We believe this combination positions the company well for its next stage of growth.”

The funding follows the launch of the nPhase.ai clinical data platform, which unifies its Unified Data Management System (UDMS) and Statistical Computing Environment (SCE) to connect the clinical data lifecycle from study startup through regulatory submission. Today, that journey can take months and require navigating numerous disconnected systems and manual handoffs. nPhase has built a unified platform that connects the clinical data lifecycle end to end, so data becomes…

Full release here, originally announced November 2nd, 2026.



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Thursday, November 5, 2026

< + > Provider Enrollment is a Data Problem Hiding in the Denial Queue

The following is a guest article by Madison Gardner, President at AMS Solutions, Inc.

A claim can pass every check a practice controls and still come back unpaid. The visit is documented, the codes are supported, and the clearinghouse accepts the file. Then the payer checks the clinicians on the claim against its enrollment records, which say something else.

Health IT teams rarely own that failure, because provider enrollment tends to be filed under paperwork. It behaves more like master data: the same facts about one clinician, held in several systems, each with its own update rule and its own deadline. When the copies disagree, the EHR and clearinghouse can work exactly as designed while the claim fails.

Four Records Describing One Clinician

The first is the national provider identifier (NPI) record. A covered provider must report changes to its required NPI data within 30 days, and a Medicare claim must carry the NPI of the billing provider and of any other provider identified on it.

The second is the Medicare enrollment record in PECOS. Physicians and their organizations have 30 days to report an added, moved, or closed practice location, and 90 days for most other changes.

The third is the clinician’s profile in the CAQH Provider Data Portal, now operated by DataSpring. Health plans use it for credentialing, enrollment, and directory management, and profiles run on a 120-day attestation cycle. The portal’s user guide tells clinicians that after any update, “you must complete attestation so that your authorized organizations can view your updated profile.” An edit saved without attestation is not the version the plans see.

The fourth is each payer’s own provider file. Cigna tells approved applicants that “we will upload your provider information into our directories and claim systems.” Under federal law, a plan must re-verify its directory entries at least once every 90 days and post a provider’s update within two business days of getting it. The same law requires providers to maintain business processes to send directory information when a network agreement starts or ends and when that information materially changes.

No rule carries an update from one record to the next.

Where the Copies Drift

A Practice Location Changes

A clinician moves to a new site, or the group opens one. The Medicare report is due in 30 days. Missing it exposes the practice to an overpayment assessed back to the date of the change and to deactivation, with an effective date that can reach back to when the practice fell out of compliance. No Medicare payment may be made while billing privileges are deactivated. The NPI record, the portal profile, and every payer file need the same new address, each on its own clock.

A Revalidation is Missed

Medicare requires each provider to resubmit and recertify its enrollment information every five years. CMS contacts the provider directly, and the response is due within 60 calendar days. Failing to furnish the information within 90 calendar days of that notice is a listed reason for deactivation. If the notice lands in a mailbox nobody reads, the first sign may be a denial.

The Group Linkage is Incomplete

Medicare pays a group for a clinician’s services through a qualifying employment or contractual arrangement, recorded as a reassignment of benefits. That reassignment carries its own effective date, set by the same rule as the clinician’s enrollment. A clinician can be approved individually while the group still cannot be paid. CMS has merged the paper reassignment form into the CMS-855I, but the transaction itself remains. Commercial plans draw a similar line: Aetna states that credentialing is different from contracting and that both must be complete before a clinician is in network.

Reconcile Before Go-Live

Timing is why this belongs early. Medicare dates a physician’s billing privileges from whichever comes later: the filing of an application that is eventually approved, or the first day of care at the new location, and outside a declared disaster, retrospective billing reaches back at most 30 days, and only where circumstances prevented enrolling in advance. A gap found after go-live can leave services that are never recoverable. For each new clinician or new location, onboarding should include:

  • A side-by-side comparison of all four records on the fields claims use: legal name, NPI, practice location address, specialty, and group affiliation
  • Confirmation that the Medicare reassignment to the billing group, not only the individual enrollment, is approved and effective no later than the first scheduled visit
  • Confirmation that the portal profile was attested after its last edit and that the group’s plans are authorized to view it
  • Written confirmation from each plan that the clinician is loaded at the correct location in both the directory and the claim system
  • Calendar dates, each assigned to one accountable person, for the next attestation and the next Medicare revalidation

What Belongs in Denial Follow-Up

Denial work should detect drift, not absorb it. When a denial traces to enrollment, resubmitting the claim does not repair the record, and each resubmission is time the record stays wrong. Those denials should route to whoever owns the record, with the finding logged against the clinician rather than the claim.

The lasting fix is a change trigger. Any change to a clinician’s location, group, or legal name should open a single task that updates all four records, timed to the shortest applicable clock. For a practice location, that clock is 30 days.

Practices have spent years making claims cleaner before submission. The enrollment record is the part of every claim the practice never sends, and payment still depends on it.

About Madison Gardner

Madison Gardner is President of AMS Solutions, Inc., a physician-founded medical billing, revenue cycle management, and credentialing company that has served physician practices nationwide since 1992. The firm’s coding and billing staff hold AAPC credentials.



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< + > Vera Health Raised $32 Million | SpendRule Raises $4 Million

Check out today’s featured companies who have recently raised a round of funding, and be sure to check out the full list of past healthcare IT fundings.

Vera Health Quietly Became One of the World’s Most Used Clinical Tools. Now It Has Raised $32 Million to Give Every Clinician in the World the Best Medical Knowledge in Seconds

With a Team of Just 12 Employees, the Clinical AI Company has Grown Largely Through Physician Referrals, Bringing Total Funding to $32 Million

A year ago, a few thousand clinicians were using Vera Health. Today, more than 800,000 are, most having discovered the platform through a colleague. Every month since June, Vera has been the most downloaded clinical app in the world across the App Store and Google Play. In September alone, it was downloaded more times than OpenEvidence and Doximity combined, while monthly downloads had more than tripled since February. With a team of just 12 employees, Vera has reached clinicians in 190 countries, including approximately 1 in 4 physicians in Spain and Italy, largely through word of mouth. Vera Health is a clinical AI search engine that reasons like a clinician, helping physicians find and evaluate medical evidence in seconds.

Today, Vera Health announced a $28.5 million Series A led by Threshold Ventures, with participation from Mantis VC and SV Angel. Existing investors Y Combinator and Gradient tripled down in the round, bringing the company’s total funding to $32 million. The investment will accelerate Vera Health’s mission to close the gap between what medicine knows and what every patient receives.

Only a few months after raising its Series A, Vera already has more daily active users than it had monthly active users at the time of the raise. Clinicians went from asking Vera a few thousand questions a day to asking hundreds of thousands, every single day.

“Clinicians are the best data scientists I’ve ever met. They make the call in seconds, with more evidence than any human could ever read,” said Taieb Bennani, Co-Founder of Vera Health…

Full release here, originally announced October 27th, 2026.

SpendRule Raises $4 Million with Backing from Mark Cuban to Build the Decision Layer Between Contracts and Payments

Seed Round Led by Mark Cuban’s Radical Investments, With Participation from Zeal Capital Partners, Will Expand SpendRule’s Work With Health Systems and Support Broader Applications of Its Contract Enforcement Technology

SpendRule, an AI contract enforcement platform that ensures health systems pay exactly what their purchased services contracts say, today announced a $4 million seed funding round led by Mark Cuban’s Radical Investments, with participation from Zeal Capital Partners. The round brings SpendRule’s total funding raised to $6 million.

The new funding will allow SpendRule to deepen its work with health systems, invest further in product development and engineering, and bring the same contract enforcement technology built for complex healthcare contracts to a broader range of businesses.

“Companies spend all this time negotiating contracts, but what’s the point if nobody checks whether they’re getting what they paid for? That’s the problem SpendRule is solving,” said Mark Cuban.

SpendRule has $2.91 billion in annual contracted purchased services spend across 2,187 business relationships as it builds infrastructure for businesses and AI agents. The platform connects negotiated terms to actual transactions and the evidence needed to enforce them, helping organizations prevent overpayments, recover money they’re owed, and protect the value of what they negotiated. As AI agents increasingly buy, approve and pay on companies’ behalf, SpendRule provides the decision layer they need to understand what each contract allows and act accordingly.

“Every company makes commitments it can’t monitor, enforce or keep current,” said Joseph Akintolayo, Co-Founder and Co-CEO at SpendRule…

Full release here, originally announced October 29th, 2026.



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< + > Weekly Roundup – November 7, 2026

Welcome to our Healthcare IT Today Weekly Roundup . Each week, we’ll be providing a look back at the articles we posted and why they’re impo...