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 spending
Inflation, Recession Fears Increase Tension Between Healthcare Patients and Providers
What You Should Know:
- Weave (NYSE: WEAV), the all-in-one customer communication and engagement platform for small- and medium-sized businesses, today announced new research, the 2023 Healthcare Business Insights Report, which examines how inflation and recession fears are impacting small healthcare offices, the patient experience and the strength of patient-provider relationships.
- The healthcare industry has become increasingly more competitive in the last five years. The sheer
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43% of Consumers Spend Up To A Month Correcting Billing Errors
What You Should Know:
- In the online survey administered to 800 U.S. consumers who had found at least one medical billing error in the last five years, 41% of the consumers are significantly frustrated trying to address billing errors.
- Zelis, a company modernizing the business of healthcare, announced findings from a new study on consumer billing conducted in partnership with Hanover Research, an independent research firm. The full results and insights are featured in the
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Healthcare Payment Integrity: Insourcing vs. Outsourcing
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
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20 Executives Share Health IT Predictions to Watch in 2023
We asked several healthcare executives to share their health IT predictions and trends for 2023.
Nate Maslak, the co-founder/CEO of Ribbon Health
Data Personalization: 38% of consumers want more personalized and inclusive healthcare options. In 2023, we’ll see a greater shift towards healthcare enterprises prioritizing this personalization, by innovating their current data infrastructure to show a range of information that lets a patient make an educated care decision based on what
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How Community Health Investments Will Define The Future of Healthcare
Community health is more than how someone’s physical health needs are being met. It involves all the physical, social, and environmental factors — access to nutritious food, stable income and housing, education opportunities, and more. These social determinants of health, or SDoH, are interconnected and integral to the overall health of communities across the world — and healthcare systems are taking note.
With the onset of the COVID-19 pandemic, it became clear one person’s health could
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The Desire for Cost Savings Driving Key Trends in Healthcare Market
The healthcare market underwent significant changes during the pandemic as patients rethought how they received care, including opting for more telehealth and deferred elective procedures, but patient care is now normalizing as patients return to the office. However, payers are working to reduce the cost of care to reel in healthcare costs and keep premiums lower to remain competitive, driving key changes.
Ambulatory Surgery and Home Care
Surgeries are increasingly moving away from
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GRAIL, Carrum Health Partners to Help Employers Address Cancer Care
What You Should Know:
- GRAIL and Carrum Health announce a partnership to help self-insured employers improve care outcomes for their employees while also reigning in the rising cost of healthcare spending for this group: CANCER.
- This product integration will enable employers who offer Carrum Health benefits to provide eligible employees the Galleri test as part of the comprehensive cancer care Carrum delivers.
- Members who receive a signal detected from the Galleri test can work
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SDoH: The Power of Proactive Social Care
As we emerge from a public health crisis that magnified and exacerbated health disparities, the need to address social determinants of health (SDOH) has reached a pivotal moment. In both social and healthcare, the pressure is mounting to address key drivers of health and amplify value-based care models.
To succeed, these models need to be effective and measurable as we work to build trust with all stakeholders (e.g., at-risk individuals, health plan members, community
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Inflation Could Result in Additional $370B in Healthcare Costs by 2027
What You Should Know:
- McKinsey & Company’s latest report reveals inflation could result in $370 billion in an additional increase above the baseline in healthcare costs by 2027, causing the government, employers and consumers to burden the cost.
- The piece showcases the impact healthcare inflation will have over the next five years without immediate action, threatening affordability and access to care for consumers, and posing a material risk to profitability for providers, payers,
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