In 2020, the Department of Justice estimated that fraudulent, wasteful, and abusive (FWA) billing practices account for more than $100 billion of the nation’s healthcare expenditures.1 Today, the National Healthcare Anti-Fraud Association (NHCAA) conservatively estimates that healthcare FWA costs the nation about $68 billion annually, representing 3% of the nation's $2.26 trillion in healthcare spending.2 FWA estimates from commercial health plans range as high as $230 billion annually, or
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Healthcare Algorithms | News, Analysis, Insights - HIT Consultant
M&A: MultiPlan Acquires Benefits Science LLC for $160M
What You Should Know: MultiPlan, a provider of data-enabled cost management, payment, and revenue integrity solutions for 700+ healthcare payors announced the acquisition of Benefits Science LLC (BST) for $160M in cash and stock.BST was founded in 2012 by a group of MIT-trained experts in data science, including Dimitris Bertsimas, Ph.D., who is recognized as an early pioneer in healthcare analytics and who serves as the company’s chief data scientist. Dr. Bertsimas will continue with BST
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How AI Can Deliver Benefits in Healthcare Manufacturing and Patient Device Usage
According to Grand View Research, the global artificial intelligence (AI) in the healthcare market size was valued at USD 15.4 billion in 2022 and is expected to grow at a compound annual growth rate (CAGR) of 37.5% from 2023 to 2030, to reach an estimated USD 208.2 billion. That’s an impressive growth rate, indicating the expected value delivery to a mostly early-phase adoption of AI in the healthcare marketplace. With such aggressive predicted growth, many health industry professionals
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Consumer Trust: How Healthcare Organizations Can Build Confidence with AI
Trust is a vital component of healthcare. It impacts whether someone shows up for a doctor’s appointment, follows their treatment plan, or plays an active role in their health. But building trust doesn’t just happen at the front counter, inside the doctor's office, or in face-to-face interactions. Increasingly, consumers are interacting with their health plans through online and mobile touchpoints — and these virtual experiences are no less crucial to building trust than in-person
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Children’s Mercy Kansas City Launches Patient Progression Hub
What You Should Know: - Children's Mercy Kansas City launches its Patient Progression Hub – a hospital operations center that uses artificial intelligence (AI), predictive analytics and real-time information to optimize care progression and coordination from the time a patient's admission is requested until discharged. - The Patient Progression Hub is part of a strategic collaboration with GE Healthcare to improve access, streamline the flow of patients, enhance discharge planning,
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Bringing The Customer Voice to Life in Healthcare
Voice is a powerful tool. The average person speaks about 7,000 words daily (although anyone who’s spent time around young children knows that estimate is probably low). Yet amid healthcare organizations building a more customer-centric approach to customer experience (CX), many have not included a key piece of the CX puzzle: analyzing the voice of the customer. The value of unstructured data Healthcare organizations use a variety of existing touchpoints to connect with their customers.
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What Role Can Consumer Health Technology Play in Diagnoses?
There’s an ongoing debate regarding the role that consumer health technology, like wearable health devices (i.e., smartwatches), can play in diagnostics, now and in the future. Because this is a relatively new technology, the scope of its potential impact is, at present, only scraping the surface. Even so, smartwatches and their connected health apps are reshaping the healthcare industry. This technology has the ability to not only make personalized healthcare more widely accessible, but its
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Risk Adjustment 2023: Which Vendors Drive Value in a Shifting Market?
What You Should Know: Strategies employed by payers, provider-sponsored health plans, and provider organizations are starting to become more proactive, and the need for solutions with prospective, predictive capabilities is rising. Additionally, amid rising healthcare costs and economic uncertainty, organizations are looking for solutions that deliver more for less.A new KLAS report examines risk adjustment vendors’ abilities to drive outcomes and value, their prospective capabilities,
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AristaMD Launches Unified Care Transition Platform
What You Should Know: - AristaMD, a digital healthcare company specializing in eConsult and referral management services, today announced the launch of a unified care transition platform. - The platform seamlessly integrates patient-to-provider matching, electronic referral processing, and eConsults into one single interoperable solution for primary care providers (PCPs). The end-to-end referral solution ensures that all patients receive timely care from the right provider in the right
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The Future of Digital Transformation in Hospitals
Hospitals are increasingly motivated to drive digital transformation in order to improve patient outcomes, reduce costs, meet regulatory requirements and stay competitive. Additionally, digital transformation can support medical research and drive innovation in healthcare, as well as generate new revenue streams. An increasingly important tool as hospitals undergo these transformations is federated learning, a technology that we will expand on later. Federated learning is a machine learning
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