Payers place many resources—including time, personnel, and money—into maintaining provider networks for their plans and members. What is the intended goal after negotiating and contracting with networks? An accurate and comprehensive provider directory containing in-network clinicians and specialists that members can effectively use to “find a doctor” when they need care.
In reality, though, this is often an elusive goal. Members frequently find themselves haunted by ‘ghost
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Cyberattacks: A Recipe for Nurse Burnout and Compromised Patient Care
Nurses, the backbone of the medical field, have been facing a critical threat: burnout. A recent survey by the National Council of State Boards of Nursing found that nurses are under immense strain due to high workloads and stress, with a significant portion of nurses (between 45% and 56%) feeling emotionally drained, exhausted, and burned out regularly. A worrying 29% of nurses reported feeling like they're at their wits’ end several times a week or even daily. Characterized by emotional
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7 Strategies to Modernize The Healthcare Payment Ecosystem
Submitting and paying claims is the financial underpinning of the U.S. healthcare system, a system plagued with inefficiencies that create disconnects between health plans and health systems. As a result, revenue cycles and claims systems are clogged, the patient and member experience is disrupted, care quality is suffering, and innovations in care delivery are constrained.
The solution? Modernization.
Modernizing the healthcare ecosystem reduces wasteful administrative
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Responsible AI in Medicine for Underserved Populations
Artificial intelligence (AI) is making a tangible difference in healthcare today. It's not about science fiction or flashy gimmicks. It’s not about deep fakes or plagiarized term papers. AI is being responsibly used to prevent medical errors, enhance clinical decision-making, expand access to care, and lower costs. While there's certainly overenthusiasm and misleading claims about AI, we can't ignore the many instances where it's making healthcare more efficient, effective, and
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How Virtual Primary Care Can Enrich Your Practice
The COVID-19 pandemic made the word “virtual” a part of our everyday lexicon. Many services that were previously done in person—even schools—quickly made the transition to being virtual. Today, our world is forever changed as many services that once were only in-person continue to be virtual due to convenience, accessibility, and technological advancements that enable everything online.
Primary care has also benefited from virtualization of services. According to a study published in
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AI-Assisted Diagnostic’s Intersection with Risk Assessment: The Future of Medical Device Technology
From predictive analytics to personalized treatment plans, we’ve probably all heard about AI's potential to revolutionize medical diagnostics and treatment. As discussed in a recent NIH study, “more recently, state-of-the-art computer algorithms have achieved accuracies which are at par with human experts in the field of medical sciences.”
However, as AI algorithms increasingly integrate into medical devices and become more influential in diagnoses, ensuring the safety of the patients they
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Clinical Trials Must Be More Equitable, Here’s How
The Need to Address Accessibility Gaps
Clinical trials are a driving force of medical innovation. However, they are predominantly conducted in large urban hospitals that have larger staff and more resources, which puts trial participation out of reach for the majority of Americans who live outside of major city centers. Despite having as much interest as city-dwellers, these individuals often find participation in clinical trials nearly impossible due to daunting travel, logistical and
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Why Wastewater Monitoring is Being Tapped to Prevent an Avian Flu Pandemic
When the Biden Administration announced its plan of action to respond to the threat of avian H5N1 flu, most of the steps being taken were similar to previous threats – targeted patient and animal screenings, bolstered laboratory capacity, and regular communications with and updates for the public and policymakers. But one item on the list may have struck people as newer than the rest – the incorporation of wastewater monitoring into an emergency response. The federal government allocated $3
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Cracking the Nutritional Puzzle: A Path Out Of Dallas’ Food Desert
Recently, I was shocked to hear that North Texas is one of the hardest-hit areas of the country for food insecurity. Shocked, but not surprised. As having been a registered dietitian and part of the Dallas Accountable Health Community (DAHC)[1] program, I have seen Dallas County’s food depravations firsthand, and while this food desert may seem trackless, I believe that by using data, we have ways to create oases.
It turns out that Dallas County has the highest rate of food insecurity
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Navigating the Final CMS Medicaid Managed Care Rule (CMS-2439-F)
On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) released the final rule, Medicaid Program; Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality. The rule aims to promote consistency and transparency, with an increased focus on improving access, driving quality, and advancing equity for Medicaid beneficiaries. CMS has been moving in this direction for several years, and states managed care organizations, and providers have
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