Faced with shifting regulations, growing administrative complexity, high-dollar claims, and the looming potential of audits, payment integrity is an increasingly important priority for payers. Payers realize that when they make the correct payments to providers initially, they increase trust, reduce provider abrasion, and lower appeal rates.
Traditionally, many health plans have outsourced payment integrity work to vendors who perform reviews, and then return the results to those health
Read More
The Future of Digital Payment Trends in Healthcare to Watch
Staffing shortages, cost of care delivery and reimbursement changes have put more pressure on healthcare practices to do more with less. Recent technology advancements have come to the rescue and enabled healthcare organizations to simplify processes, improve communication efforts and ultimately support staff and patients alike.
Patient payment tools are an example of a technology solution that has been around for years but has not been widely adopted. However, as technology has
Read More
The Continuing Rise of AI in the Healthcare Sector in 2023
The announcement in September 2022 that the health tech company Iodine Software was entering into a partnership with the software platform TruCode “to upend clinical administration using artificial intelligence” serves as one of the more recent reminders of AI’s considerable impact on the healthcare sector.
Certainly, it will be felt not just in the administrative realm, but also in the clinical and operational aspects as well. And given the challenges presented by a rapidly aging population,
Read More
Why ML Monitoring is Essential to AI Success in Healthcare
Artificial intelligence (AI) adoption in the healthcare sector has grown significantly over the last decade, with no signs of slowing down. According to a 2021 report from HIMSS, 62% of clinicians are interested in using AI/ML tools.
From front-line workers to back-office staff, every stakeholder in the healthcare continuum can leverage AI technology to enhance healthcare quality. In fact, ML models are already being used to collect and analyze patient data at scale, thereby allowing
Read More
Key Multi-Cloud Takeaways & Mistakes to Avoid for Healthcare CIOs
Healthcare has lagged in its adoption of multi-cloud—but that might not be a bad thing. Here are the top multi-cloud takeaways for healthcare CIOs, and the key mistakes to avoid.
It’s no secret that the healthcare sector has been one of the slowest to adopt enterprise cloud computing, even with the moderate increase we saw as a result of the urgent shift to telehealth and remote working during the pandemic.
But that’s understandable: healthcare is one of the most highly regulated
Read More
How Tech Can Improve Health Plan Performance & Star Ratings in 2023 & Beyond
The open-enrollment period that recently concluded for U.S. health plans was the first since the expiration of pandemic-linked changes to how Star Ratings were calculated. This is a period of major transition for the industry, with some health plans struggling to maintain their previous ratings and plan participants, who are now accustomed to home-based testing and treatment, expecting those services and features to continue. Fortunately, new technology can help health plans boost plan
Read More
Liver Cancer Awareness – Here’s What You Need to Know in 2023
By the end of 2022, nearly 42,00 new cases of primary liver cancer will be diagnosed in the United States. In fact, liver cancer incidence rates have more than tripled since 1980, marking an increased need for better detection and diagnosis.
We might not talk about liver cancer as much as we do breast or lung cancer, but it’s a real threat to millions of Americans – and we need to continue spreading awareness.
Early detection is especially critical in treating liver cancer.
Read More
Why We Need Deflection to Reduce Overdose Deaths (and Drug Diversion) in 2023
The United States is still reeling from a devastating opioid epidemic. The Centers for Disease Control and Prevention (CDC) report that death from drug overdoses reached just under 108,000 between 2020 and 2021. That is enough to fill over four professional baseball stadiums.
This staggering number of overdose deaths is due to many factors, including the sale of counterfeit medications and illegal drugs that often contain deadly doses of illicitly manufactured fentanyl and other
Read More
The Patient Journey Tech Stack: 10 Pharma Predictions for 2023
The complexity of demands on Market Access teams has increased in recent years, between introducing innovative therapies targeting smaller populations and higher bars from Payers and PBMs.
Now, drug manufacturers are bucking up. According to the IQVIA Institute, the prescription abandonment rate has reached 27 percent, or $76 billion annually, in specialty drugs alone. This squandered revenue has led manufacturers to increase their focus on the complex, nuanced patient journey.
As a
Read More
5 Things to Consider Before Implementing a CAPS System in 2023
Core administrative processing systems (CAPS) serve as the center of the healthcare payer architecture and are essential for efficient business operations. These systems are needed to support administrative and transactional processing and are a significant investment in technology. Selecting a CAPS system isn’t a single purchase, but rather an ongoing partnership that requires maintenance to ensure the system remains up to date to support industry and regulatory changes. Last year, 99% of
Read More
