The efforts to develop a COVID-19 vaccine focused the world’s attention on the pharmaceutical industry. Before the pandemic hit, very few people outside of the healthcare industry understood what it takes to develop a new drug. Nor did they consider the complexities of administering the various medications that require a regimen that goes beyond “take one pill each morning.”
The biopharmaceutical industry is massive, accounting for more than $1.3 trillion in economic output, representing four
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RCM: How Coding Gray Areas Skew Healthcare Data
Clinical reality, the ICD-10-CM classification system, and considerations of reimbursement are three distinct worlds that are sometimes in conflict. We don’t like it when financial considerations intrude on the purity of coding, but there’s no escaping this intrusion when coding serves as both the representation of the clinical picture in healthcare data and as the basis for reimbursement.
Sepsis Definitions at Odds
Sepsis provides a great illustration of a coding gray area that can
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AI + Human Intelligence — A More Effective Solution for the Healthcare Payment Lifecycle
Much has been written about the advent of Artificial Intelligence (AI) in the healthcare payment lifecycle, but has it been oversimplified? The straightforward answer is yes.
Many articles have characterized AI as the end-means antidote that will solve all revenue cycle management (RCM) issues and easily streamline the reimbursement process from beginning to end. In fact, many of the products in today’s marketplace promise a complete solution based almost entirely on AI. But, looking at this
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Surprise! Patient Engagement is About the Individual
It’s well understood that patient engagement leads to better outcomes. A powerful way to boost engagement is by delivering a personalized care experience so that patients can manage their condition in a way that best aligns with their lifestyle and goals.
Two of the most effective patient engagement initiatives include: 1) clinicians spending more time with patients and, 2) shared decision making. Although clinicians would prefer more face-to-face time with patients to better assess their
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Will U.S. Healthcare Have The Same Success Rate With Chronic Kidney Disease As Native Americans?
For years, hypertension has dominated the healthcare field, afflicting 45 percent of all adult Americans, inducing a number of lethal complications in patients across the country. Another disease that has gained renown in the world of healthcare is diabetes, afflicting 10.5 percent of the U.S. population with its own complications.
Healthcare professionals have allocated untold assets in the form of time, money, and personnel to minimize the impact such diseases pose yet the relative
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Data Reveals Institutional Racism in Healthcare Still Exist, But Providers/Payers Can Change That
The vaccine rollout is following patterns that are all too familiar -- but we can change that
Newscasters sounded surprised when they announced for the first time that COVID-19 was disproportionately affecting Black, Indigenous, and people of color. As they presented graphs that showed higher rates of infection, hospitalization, and death, their tone was one of mild shock.
Similar surprise-- and similar graphs-- returned when they reported on the slowed, uneven vaccine rollout in poorer
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KLAS: Growth of Drug Diversion Monitoring Market
Often when we talk about the opioid epidemic, the focus is rightly on the suffering that the situation has caused. However, it’s important not to miss the surrounding context of this crisis, and what various health systems have started to uncover.
Currently, health systems face a huge challenge in tracking and managing their controlled substances. One of the technology-based solutions to the problem is drug diversion monitoring systems, which KLAS reported on in a recent report. While
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The Role of Digital Mental Health in the Healthcare Journey
With more than 20,000 apps available to address myriad mental health challenges with varying degrees of support, it’s clear that digital mental health is experiencing a boom. But there seems to be little consensus regarding the true role that digital therapeutics can and should play within the greater context of a patient’s mental health care journey. In order to better articulate this role, we need to take a person-centered view and understand how digital therapeutics can help people not just
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Why Provider-Payer Collaboration is the Secret to Value-Based Success
Just before the COVID-19 pandemic emerged, 48% of healthcare providers surveyed said three-quarters of their organization’s payments were grounded in fee-for-service models of care. Fast forward a year and the financial aftershocks of the pandemic have highlighted some of the benefits of value-based models for providers as well as health plans and consumers.
Despite the benefits of incentive-based payment models in healthcare, including indications that it may reduce readmissions and
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Applying A Hedge Fund Mentality for Investing in Social Determinants of Health
While I am a practicing clinician, I am a firm believer that improvements in healthcare most often come from borrowing the best ideas from other business models. For example, I have sometimes borrowed from software company and payer colleague insights to describe value-based care (VBC) reimbursement as a subscription model. This model would provide more consistent revenue and allow organizations to better weather challenging times like a pandemic. For providers, this would allow freedom from the
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