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
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CMS| News, Analysis, Insights - HIT Consultant
How Can Providers Support Meaningful Price Transparency to Address Consumerism in Healthcare?
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 the answer to these fundamental questions: What do patients
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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
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Revenue Leakage: 3 Methods to Revive Your Charge Integrity Program
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 considered or quantified the potential dollars lost when
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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
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Geisinger Appoints Dr. Jaewon Ryu as New CEO
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 Geisinger earlier this year to
assume a leadership role at Google.
“On
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3 Ways Health Plans Can Leverage Lab Data Analytics
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 category includes data on critical health factors such as
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Applied Analytics: Making the Dream of Cost-Controlled Population Health a Reality
Ninety percent of a solution is accurately defining the problem, however, in healthcare, much like nearly every other industry, more time and energy is spent on fixing perceived symptoms rather than identifying root caU.S.es.
Today we will explore the contribution that applied analytics has made and continues to make on bending the dramatic U.S. healthcare cost curve. To do this well we will first explore the primary cost drivers (i.e. root caU.S.es), as to why the U.S. spends more on care than
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You Want Patient Engagement? Make The System Navigable
Last month, New York Times reporter Robert Pear died at age 69 from complications of a stroke. The name was unfamiliar to me, and I guess that’s to be expected, given what I’ve learned of the man since.
Turns out Robert Pear was a thoughtful, unassuming reporter who wanted the accuracy and validity of his work to speak for him. This approach engendered much respect among his peers in the 40 years that he primarily covered healthcare policy.
“Robert was an exacting reporter,” writes
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Innovaccer Launches ACO Comparison & Performance Enablement Tool
Innovaccer Inc., a San Francisco-based data activation company, today announced the launch of the brand new version of its ACO comparison and performance enablement tool, ACO Compare. With Innovaccer’s latest offering, ACOs can figure out concrete strategies and build comprehensive roadmaps to achieve their goals based on in-depth analysis and regression on critical data points.Growing Importance of Understanding The Value-based Care LandscapeWhile ACOs have traditionally been considered to be
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