TurningPoint Healthcare Solutions

In honor of National Nurses Week, we're honored to share reflections from the nurses at the heart of TurningPoint Healthcare Solutions. 🩺 #NursesWeek2026 #ThankANurse

This week we celebrate nurses — in our organization and across healthcare.   To the nurses at TurningPoint: your clinical expertise and dedication are what make this organization work. We're grateful for you every day.   To nurses everywhere — in hospitals, clinics, home settings, and every specialty in between: thank you.   Healthcare doesn't function without you, and we’re all better for it.   Happy National Nurses Week. #NursesWeek2026 #ThankANurse

Prior authorization started as a peer-to-peer clinical conversation. Somewhere along the way it became an administrative bottleneck. David Halsey, M.D. on what it was supposed to do — and what it takes to get back there.

Medical knowledge is doubling every 73 days. A single biologic can exceed a million dollars. And the variation in MSK and cardiovascular care represents the largest unmanaged cost exposure in specialty care today. At AHIP MMDC26, that was the backdrop for a conversation with CMOs from CareSource and AmeriHealth Caritas D.C. about what closing that gap actually requires. Five takeaways from the panel — link in the comments. #SpecialtyCare #MSK #Cardiovascular #HealthPlans #ValueBasedCare

Good discussion this week at AHIP MMDC26 with clinical leaders from CareSource, AmeriHealth Caritas, and PwC alongside David Halsey, M.D. One theme that came through clearly: as more clinical decision-making becomes automated, the remaining higher-complexity specialties like MSK and cardiac require deeper sub-specialty expertise to manage effectively. Appreciate the perspective from the group and the engagement from those who joined.

TurningPoint is on the ground at AHIP MMDC26. This afternoon, we’re joining leaders from AmeriHealth, CareSource, and PwC for a discussion on how health plans are approaching complex specialty care - particularly where earlier decisions around site of service, provider selection, and clinical alignment begin to shape cost, access, and accountability. Featuring TurningPoint’s, Chief Clinical Officer David Halsey, M.D. At the event? Join us at 2:30.

Specialty conditions continue to shape overall cost, complexity, and member risk for health plans. As markets face enrollment shifts, rate pressure, and rising specialty variability, health plans are rethinking how they approach high‑impact specialty categories. At AHIP MMDC26, TurningPoint will join leaders from across the industry to explore how payers can drive greater stability and innovation in specialty care. We’ll be discussing: - How payers are reassessing specialty risk amid market volatility - Where legacy specialty care models are falling short - How deeper clinical alignment creates more stable, predictable care pathways Looking forward to a great conversation with Lydia Turner, David Halsey, M.D., David Williams, MD, FACP, and David Granger, MD, MPH, MBA, FAAP

Recent Medicare Advantage data shows that more than 80% of appealed denials are overturned. I don’t read that as a denial statistic; I read it as a signal about clinical misalignment.   If prior authorization is functioning as an expert second opinion, most of the clinical dialogue should happen upfront - between physicians who understand the specialty, the evidence, and the nuance of the case. Appeals shouldn’t be routine but instead represent true clinical gray areas.   When subspecialists are engaged early, and peer-to-peer conversations are meaningful, you see fewer escalations and more consistency in decision-making.   Prior authorization doesn’t have to feel adversarial. At its best, it’s structured clinical collaboration. Source: KFF analysis of Centers for Medicare and Medicaid Services data

We look forward to presenting at the 2026 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) .   David Halsey, M.D. and Charles Hannon, MD, MBA will discuss an upcoming pilot evaluating alignment between AAOS Appropriate Use Criteria (AUCs) and medical policy criteria at submission for MSK surgical procedures.   We appreciate the opportunity to contribute to the broader conversation around evidence alignment in orthopaedic care.

Please join us in welcoming three outstanding healthcare leaders to TurningPoint! Amy Bertotti, DBA, MSN, RN - Vice President, Clinical Operations Kathleen Salings - Vice President, Client Success Mara Milne - Senior Vice President, Business Development Each brings proven experience across payer operations, client engagement, and strategic growth - further strengthening TurningPoint's mission to improve the safety, quality, and affordability of specialty healthcare. We’re excited for what their leadership will bring.