A health plan’s success rests on many factors: improving health outcomes, controlling costs, optimizing risk adjustment, and encouraging member adherence to a specific care plan. Member engagement is foundational to all of these goals.
Health plans have struggled to close the loop on engagement for various reasons. This is especially true among Medicaid enrollees, who report more problems with prior authorization and provider availability compared to people with other
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Interoperability: The Missing Link to Combat Nurse Burnout
The American Organization for Nursing Leadership recently published a report that reinforces the troublesome trend in healthcare: Nearly one-fifth of nurses are projected to leave the healthcare workforce by 2027. Nurses are central to the success of patient outcomes, so how can technology empower and support this dedicated group of professionals within the patient care space to feel satisfied in their role?
Problem
Inadequate staff and increasing complexity of patient conditions
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Combat Health Misinformation with Conversational Intelligence
The digital era presents healthcare leaders with a formidable challenge: a tidal wave of online health misinformation shaping patient behaviors and decisions. A single viral social media post can ignite widespread confusion, driving patients to pursue treatments, medications, or services that may—or may not—relate to their condition or patient journey. Healthcare organizations then scramble to manage surging call volumes, strained resources, frustrated patients, and a compromised healthcare
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From Comfort to Cure’: Answering the Call of ASCO 2024
The landscape of cancer treatment has continued to evolve, and the annual ASCO Meetings often set the stage for “what’s next in cancer care.” The overarching narrative at the 2024 ASCO Annual Meeting “From Comfort to Cure,” calls providers to view treatment plans with an emphasis on quality of life. To answer this call, we must implement solutions that enable providers to maintain the quality of life without compromising the quality of care.
Quality of life is personal
Providers
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How Debt-Free Education Programs Can Reduce the Healthcare Staffing Shortage
The U.S. is currently suffering from a severe shortage of healthcare workers, including physicians, nurses, and allied health roles. For the second year in a row, hospital CEOs cited workforce challenges as their top concern on the American College of Healthcare Executives annual survey. And the situation is only predicted to get worse. For example, the Bureau of Labor Statistics estimates that, by 2030, the U.S. will face a shortage of 275,000 nurses.
Certain contributing factors to this
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Streamlining Patient Transitions for Better Outcomes
For patients, every transition of care to a different facility brings the risk of complications.
When a patient is transitioning from a hospital to a post-acute care facility, for example, essential patient information relating to medical history and medication lists may be lost, overlooked, or not shared, resulting in delays to treatment and suboptimal care.
Like many things in life, successful transitions of care often start with strong communication. To match patients to the
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Hospitals: Integrating CDI and UM for Improved Revenue Cycle
Forward-thinking hospitals have long recognized clinical documentation integrity (CDI) and utilization management (UM) as priorities for a successful revenue cycle. The current economic climate only underscores their importance. The latest performance trends data from Strata Decision Technology noted that, while operating margins remain stable, payment volumes experienced a shortfall of nearly 18% in Q1 of 2024.
Now is the time for hospitals to explore how to further automate and
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Future-Ready: 10 Best Practices to Improve Prepay Claims Editing
In the fast-evolving and intricate landscape of payment integrity, the value of prepay editing is paramount. As powerful AI and advanced analytics are being applied earlier in the claim adjudication process, the importance of next-generation claim editing capabilities will separate health plan leaders from laggards.
If you’re equating claims editing with medical savings alone—you’re missing the boat and the opportunity. Because forward-thinking payment integrity and claims operations leaders
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Cybersecurity: Building a Resilient Healthcare Practice in the Face of Cyber Threats
A healthy patient-provider relationship is the foundation for delivering quality healthcare, yet increasingly occurring cyberattacks have negatively impacted patient health outcomes, data security, and care operations. With the recent cybersecurity breaches causing disruptions to operations and workflows that require a shift to manual and paper-based processes, providers must take all necessary technical steps to protect their patients, staff, and practice reputation from potential
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Alarming Rise of AI Voice Deepfakes: Waging War on Healthcare
Imagine you’re an IT professional for a large health system. A resident physician calls and says he must urgently send in a patient script, but he’s locked out of the system and needs a password or account reset. You recognize his voice. He provides his ID number and other credentials for verification. You successfully restored his access so he can log in – only, it wasn’t the doctor that you just spoke to. It was a cybercriminal.
Increasingly, threat actors are using social
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