Editor's Note: Co-written by Scott Herbst, Senior Vice President and General Manager of Provider Solutions and Ryan Miller, Senior Vice President of Strategy & Corporate Development at Availity.Prior authorizations may be as popular among providers as ants at a picnic, but they have become a common and necessary part of the reimbursement process. As a result, being able to manage prior authorizations efficiently is critical to maintaining a healthy revenue cycle and avoiding issues such as
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5 Considerations to Enable a Modern Healthcare Commerce Strategy
The healthcare industry is facing a number of external market forces that are creating the perfect pricing storm. Industry consolidation, regulation and new demands for transparency are putting added pressure on healthcare manufacturers, with many left wondering about how they can profitably compete. Over the last three decades, more than 1,000 healthcare manufacturers have been acquired due to competitive consolidation. The catalyst for this volatility can be attributed to the lack of
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Population Health Management Means the Whole Population, Not Just the Highest Need
Considerable attention has been given to the large proportion of healthcare spending concentrated among a small proportion of patients. This five to 10 percent of the population has been the driving force behind many value-based purchasing models, e.g., chronic health condition management for the high cost, high utilizers, and health home models for care coordination and management services. A recent thought piece (March, 2017) in the The New England Journal of Medicine, “Focusing on
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3 Roadblocks to Achieving Interoperability In A Value-based Care System
I am sure I am not the only one who has lost count of the times I’ve been asked “Why can’t the systems talk to each other?” or, in more technical terms, “Why don’t we have interoperability?”The numerous health IT solutions that we have around us today were meant to improve not just the delivery of care, but also enhance patient outcomes as the care continues across multiple practices. At the most basic level, I suppose we can define interoperability as two or more systems communicating with each
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From Telemedicine to Better Data: How APIs Improved Health in Chile
Editor's Note: Co-written by Soledad Munoz, CIO of MINSAL, Aashima Gupta, Global Head of Healthcare Solutions at Google Cloud and Michael Leppitsch, Digital Strategies for Global Enterprises at Google Cloud. The Chilean Ministry of Health has been grappling with a big first-world problem. A significant proportion of its 18 million people suffer from chronic conditions, including obesity, diabetes, cancer, and heart disease.But implementing a national mandate to improve these statistics is
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3 Challenges and Considerations for Measuring Population Health Success
Healthcare organizations across the country are under enormous pressure to improve health outcomes, where the notion of “population health management” has suddenly evolved from a “nice-to-have” to a necessity. This prominent care initiative involves grouping patients together based on certain characteristics - age, gender, chronic conditions come to mind, just to name a few - and working to improve the health status of that group by monitoring, analyzing and improving the health of the
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Why GE Won’t Sell its Health IT Business
As John Flannery, the new CEO of GE takes on the task of sweeping cost-cutting at the industrial behemoth, recent market speculation has suggested he may be looking to offload GE’s Healthcare IT business. Here's why we think this won’t happen.Crumbling, but not to the coreGE's health IT portfolio has been compiled from many acquisitions, creating a complex and sometimes disjointed product set. At its center is a core set of software and services focused on clinical IT. GE’s products that support
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MACRA: The Yardstick for Quality that Health Systems Need
The number of quality initiatives is rapidly rising in the healthcare industry as stakeholders shift their focus toward the value of patient care. In addition, with the recent implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), the rules surrounding healthcare reimbursement are being rewritten, incentivizing healthcare providers to prioritize the quality of patient visits over the quantity.Historically, it has been difficult to achieve consensus on defining quality;
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Why Payers Must Invest in Real-Time Analytics to Increase Profitability Against ACA’S Risk Adjustment Program
With the future of the Affordable Care Act in limbo, health payers and providers alike are back to focusing on how to work within that system. And as payers in particular struggle to find avenues to profitability in the ACA’s complex topography, we’ll likely hear more rhetoric about the difficulty of enticing young, affluent Americans to sign up for health insurance.The conventional wisdom of the moment holds that failure to enroll enough of those so-called “healthy wealthies” to offset the
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The Value of EMRs: Broken Promise or Unintended Consequences?
Editor's Note: Justin Campbell is the VP at Galen Healthcare Solutions, a professional services firm helping healthcare clients migrate from paper to electronic health records. Prior to joining Galen, Justin served as the IT Director for a long-term care pharmacy, leading a paperless initiative, the migration of the Pharmacy Information System (PIS) from a legacy platform, and the integration of the PIS to the pharmacy’s packaging system.In the world of healthcare many are tempted to believe in
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