Samwise Healthcare IT Newsletter
Tuesday, May 12, 2026
MACPAC calls for increased transparency in Medicaid AI prior authorization
The Medicaid and CHIP Payment and Access Commission voted May 11 on recommendations urging increased transparency in AI-backed prior authorization for Medicaid. MACPAC recommended that CMS issue guidance requiring human review of automated care denials by someone with appropriate clinical expertise, update regulations so medical necessity denials in fee-for-service Medicaid are made by a clinically qualified person, provide states guidance on overseeing AI in utilization management, and direct states to require health plans to disclose how they use the technology in coverage decisions. States currently have “limited visibility” into insurer AI practices, MACPAC analysts said, raising risks of inaccurate decisions from data bias or technical errors.
Sources: Healthcare Dive
AHA warns health systems of Chinese cyber actors using covert networks
The American Hospital Association is directing health systems to a joint federal advisory warning that Chinese state-linked hackers are leveraging “covert networks” of compromised devices to stage cyberattacks on critical infrastructure. John Riggi, AHA national advisor for cybersecurity and risk, noted that health systems have already been targeted by Volt Typhoon and Flax Typhoon campaigns, which use such networks for espionage and to preposition for disruptive attacks. Riggi recommended that health systems audit inventories for unpatched or outdated connected devices, tighten work-from-home technology policies, monitor for abnormal web traffic, and adopt behavior-based cyber defenses to counter the threat.
Sources: Becker’s Hospital Review
Virtua Health eliminates 15,000 excess hospital days with Microsoft AI tools
Marlton, N.J.-based Virtua Health, a five-hospital system, has eliminated 15,000 excess hospital days after building AI tools with Microsoft. Power BI dashboards and Copilot summaries now give clinicians patient overviews in about five minutes, down from 30. A custom Azure AI Foundry model transforms unstructured patient notes into structured predictions—boosting heart-failure patient identification by 84 percentage points, increasing follow-up rates from 58 to 81 percent, and cutting average stays in heart-failure units by one day. A separate XGBoost model trained on EHR data and integrated into Epic reduced sepsis false-positive alerts by more than 80 percent compared to commercial tools.
Sources: Becker’s Hospital Review
Advocate Health cuts prior authorization time from 25 minutes to five with Epic AI
Advocate Health, the Charlotte, N.C.-based 27-hospital system, has streamlined prior authorization for specialty medications using AI tools built into Epic. A May 4 Epic case study details how the health system replaced phone- and fax-based workflows with digital processes that generate AI-drafted responses to payer questionnaires. Pharmacy staff time per authorization fell from as much as 25 minutes to roughly five minutes, and average submission time improved by a full day. Advocate has since expanded the AI-assisted workflow across its specialty, outpatient, and centralized retail pharmacy operations, after first collecting staff feedback to refine the technology before broader deployment.
Sources: Becker’s Hospital Review
UnitedHealth and Elevance bet billions on AI for member navigation and prior auth
UnitedHealth Group and Elevance Health are investing $1.5 billion and $1 billion, respectively, in AI this year, with both ranked among Fortune’s top companies for AI adoption. Major payers are deploying the technology across five areas: member navigation, including virtual assistants reaching tens of millions of enrollees; prior authorization—Elevance’s Health OS reduced prior authorizations by nearly 70 percent; internal automation, with UnitedHealth directing 26 million customer calls via AI agents in 2025; clinical decision-making through Optum’s Value Connect, which cut emergency visits by 29 percent; and predictive risk modeling to assist care management teams.
Sources: Becker’s Hospital Review
AMA releases 7 principles to stop AI deepfakes of physicians on social media
AI-generated deepfakes of physicians are proliferating on social media, often endorsing unproven treatments, the American Medical Association warned in a May 11 news release. The AMA published seven policy principles for preventing fake physician personas: protect physician identity as a legal right; prohibit deceptive medical impersonation; require opt-in and revocable consent before any AI-generated physician likeness is used; mandate labeling and transparency for AI-generated content; share prevention responsibility among health systems and technology companies; enable practical remedies for enforcement; and minimize the administrative burden on physicians seeking to protect their identities from AI-generated impersonation.
Sources: Becker’s Hospital Review
Researcher outlines 4 ways to expand hospital-at-home adoption nationwide
Most U.S. hospitals still lack a hospital-at-home program despite the CMS Acute Hospital Care at Home waiver existing since 2020. Austin Kilaru, M.D., a senior fellow at Penn Leonard Davis Institute of Health Economics, outlined four strategies to accelerate adoption in an April 29 news release: simplify the model by allowing lower-intensity, more-virtual care options rather than full hospital replication; fund upfront startup costs—not just per-patient reimbursement—especially for rural and safety-net hospitals; align Medicaid and commercial insurers alongside Medicare; and evolve toward bundled acute-plus-post-acute care episodes at home for better outcomes and lower costs.
Sources: Becker’s Hospital Review
Women now lead health IT at 14 of the top-100 U.S. health systems by revenue
Women are increasingly occupying top technology leadership roles at major U.S. health systems. Among female CIOs at top-100 revenue systems: Bobbie Byrne, M.D., has been executive VP and CIO of Advocate Health since 2022; Paola Arbour has been CIO of Tenet Healthcare since 2018; Sarah Hatchett has been CIO of Cleveland Clinic since 2024; Kristin Myers has been chief digital officer of Northwell Health since 2024; Jane Moran has been chief information officer of Mass General Brigham since 2021; Laura Wilt has been chief digital officer of Sutter Health since 2023; and Lisa Stump has been chief digital information officer of Mount Sinai since 2024.
Sources: Becker’s Hospital Review
Curated by JD · samwise.agency