The healthcare landscape continues to evolve rapidly, driven by advancements in technology and the ongoing shift towards alternative payment models. As payers navigate this increasingly complex environment, member engagement has emerged as a critical factor in ensuring the success of healthcare initiatives. Now, with the emergence of artificial intelligence (AI) in healthcare and value-based care, understanding and prioritizing member engagement has become more important than ever.
Patient
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Can Community Hospitals Weather the Financial Storm? What’s Needed
A recent survey of community hospitals found nearly 70% rate their financial health as “average” or poor.” In this environment, community hospitals must take a fresh look at their approach to patient financial engagement to protect their ability to provide needed care.
Hospital out-of-pocket collections declined sharply this year, down to nearly 48%, a Kodiak Solutions analysis shows. Moreover, more than half of write-offs — 53% — last year involved patients with some form of insurance,
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The Critical Importance of Payer-Provider Collaboration Goes Beyond Prior Authorization
The critical need to improve prior authorization processes might have reached its tipping point on Jan. 17. That’s when the Biden administration announced its new mandate — the CMS Interoperability and Prior Authorization Final Rule — designed to effectively speed up the process for Medicare Advantage patients, providers and health plans.
Speed is only one of many inefficiencies surrounding prior authorization. And prior authorization cases are only one slice of the patient
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Overcoming the Financial Costs of SDoH: 3 Ways Providers Can Help
Social determinants of health (SDoH) factors often take a financial toll on patients, making it more difficult for them to afford and access the care that they often need to overcome some of those same SDoH issues.
While providers certainly can’t wave a magic wand and make their patients’ SDoH struggles disappear, they can take a few concrete steps to help these patients pay for important care.
Improved SDoH, Improved OutcomesSDoH are defined as “the conditions in the
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Did AI Cause HIPAA Fines to Double in a Single Year?
In 2023, HIPAA fines amounted to $4,176,500, which is a rise of over $2,000,000 in 2022. So yes, HIPAA fines have doubled. But why?
Technology in healthcare has been a constant battle between progress and pain, and the relationship has grown increasingly complex over recent years. The Health Insurance Portability and Accountability Act (HIPAA) is one of the most well known regulatory frameworks in the healthcare industry, and it establishes safeguards for protecting sensitive patient
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Healthcare Analytics Adoption: 5 Tips for Healthcare Organizations
Healthcare organizations have access to a wealth of data, yet 92% of healthcare professionals say organizations should do more to leverage financial and operational data to inform strategic decisions, according to a recent report.
Integrating financial analytics into decision-making processes is increasingly vital as hospitals and health systems nationwide contend with high costs, narrow margins, shifts in patient demand, and other financial and operational pressures. Doing so, however,
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AI Agents in Healthcare: Retaining Talent, Improving Patient Care
The aging population is creating an unprecedented demand for healthcare services while the available healthcare workforce is declining. Meanwhile, the healthcare system continues to rely heavily on manual processes which have to date been powered by people. After a patient visit, a healthcare provider typically requires a full administration team to manage data across various systems, just to receive reimbursement
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Efficiently Sustainable: How Hospitals Can Create Operational Sustainability
If any sector requires process improvement, it’s healthcare. There are well publicized NHS waiting list woes and A&E delays, but behind these figures are workforce and operational issues that create real stress on clinical staff and impacts patient satisfaction.
Nurses spend 10% of their time searching for equipment (according to a 2009 study) and sadly little has changed in more than a decade. Another study also revealed nurses claim that they experience “16-30% preventable wasted
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The CISO Connector: Bridging Business Goals, Operations, and Security in Healthcare
The role of the Chief Information Security Officer (CISO) has evolved far beyond traditional cybersecurity responsibilities, especially in healthcare organizations. Today, a CISO must be positioned as a vital connector, aligning business goals, operational efficiency, and security needs. This strategic role is essential not only for breaking down siloes between security and operations teams, but also for fostering organization-wide adaptability, strategic thinking, and a holistic understanding
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Adopting Uniform National Provider Directory Standards Will Promote Interoperability
The concept of interoperable care centers on the ability of providers to share patient information. Still, providers continue to find navigating the exchange of patient data difficult.
A 2019 data brief from the Office of the National Coordinator for Health Information Technology underscores the interoperability challenges that clinicians face:
85% find it challenging to exchange data with EHRs that aren’t theirs73% use multiple systems or portals to exchange data71% of referral partners
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