To assist Medicare Advantage plans in eliminating these complications and achieve the top Star Ratings, Innovaccer Inc., a San Francisco-based data activation company, has strengthened its solution for Medicare Advantage plans. The solution for MA plans is a comprehensive suite of solutions designed to solve all grassroots challenges to empower MA plans to ensure healthier patients and increased profits.Rise in Medicare Advantage EnrollmentThe CMS has projected that Medicare Advantage enrollment
Read More
ACO Investment Model Reduced CMS Expenditures by $48M
The Accountable Care Organization (ACO) Investment Model (AIM) saved the Centers for Medicare & Medicaid Services (CMS) more than $48M in its first year while promoting improved health care in rural and underserved areas, according to a new study from Abt Associates.The new study reveals that after accounting for the $82.4 million provided to ACOs, AIM reduced CMS expenditures by $48.6 million. Decreases in the number of hospitalizations and use of institutional post-acute care contributed
Read More
6 Considerations For Creating A Robust Healthcare Data Analytics Program
Dr. Anunaya Jain, VP, IKS Health
Healthcare organizations are increasingly turning to data analytics to solve their toughest business challenges. As information becomes less siloed, and technology systems do a better job of both generating and sharing data, organizations are seeing the need to more precisely identify patterns to predict patient needs, anticipate resources and improve processes. There is now as much emphasis on making the data work as there was on collecting data, so it can
Read More
AI in Healthcare: Enhancing Risk Models to Predict the Future Cost of Care
Traditionally, providers and health systems have relied on claims-based risk models, such as the CMS-HCC, ACG, and DxCG, which were built to forecast the risk of populations, but not at an individual level. While these models give a fairly good estimation of the risk of the population, they exhibit unsatisfactory estimation if used to predict the risk at an individual level.Innovaccer Inc., a healthcare data activation company, has taken a major step towards revolutionizing the way we identify
Read More
How Can Providers Support Meaningful Price Transparency to Address Consumerism in Healthcare?
Sloan Clardy, President, Technology Solutions at nThrive
The word “consumerism” and its derivatives have been tossed around the broader healthcare industry for the greater part of a decade. How we define consumerism and look at consumer behavior in relation to our institutions, systems, and programs seems key to unlocking the door to better outcomes and higher margins. However, in a landscape with more disruption than ever—greater vertical integration, technology, and regulation—we still lack
Read More
J.D. Power to Publish First-Ever Telehealth Satisfaction Study Focused on 3 Categories
J.D. Power, a global leader in consumer insights, advisory services, and data and analytics announced its plan to launch its first-ever Telehealth Satisfaction Study in November 2019.Why Telehealth Satisfaction?As new value-based payment models continue to re-define the consumer healthcare experience, the use of telehealth as a lower-cost form of medical consultation has skyrocketed in popularity. Among the commercially insured, telehealth visits increased 261% between 2015 and 20171 and the
Read More
Revenue Leakage: 3 Methods to Revive Your Charge Integrity Program
Rebecca Marsh, VP of Advisory Solutions, nThrive
Many consider a strong charge integrity program the cornerstone and heartbeat of the revenue cycle. Without an effective charge integrity program, health care providers run the risk of revenue leakage.
According to the Healthcare Financial Management Association, “one percent of net patient revenue is lost due to charge capture errors,” which can add up to multi-millions of dollars for health care organizations. Most providers have not
Read More
Surescripts Inks Partnerships with National Health Plans to Streamline Prior Authorization
Surescripts announced that several national, regional and local PBMs and health plans representing virtually all U.S. patients are replacing their manual prior authorization process with Surescripts Electronic Prior Authorization solution. Over the past 18 months, several national, regional and local PBMs and health plans representing virtually all U.S. patients have signed on, increasing the number of insured lives covered by Surescripts Electronic Prior Authorization by nearly 20%.Impact of
Read More
Geisinger Appoints Dr. Jaewon Ryu as New CEO
Jaewon Ryu, MD, JDPresident and Chief Executive Officer, Geisinger
Geisinger today announced that its Board of Directors has appointed Jaewon Ryu, M.D., J.D., as president and chief executive officer. Dr.
Ryu, who has served as interim president and CEO since November 2018 and
executive vice president and chief medical officer since September 2016,
becomes the seventh chief executive officer in Geisinger’s 104-year history. He
succeeds David T. Feinberg, M.D., MBA, who left
Read More
3 Ways Health Plans Can Leverage Lab Data Analytics
Hossein Fakhrai-Rad, Founder & President at BaseHealth
Payers have long realized the value of leveraging disparate data sets to gain greater insight on patients, with popular data sources including claims, electronic health records, and surveys on social determinants and behavioral health.
More recently, health plans have begun to appreciate another source of data that can help them avoid missed revenues, predict emerging conditions and improve risk management: laboratory data. This
Read More