Today’s relationship between payers and providers is more fraught than ever. With a history of transactional, often adversarial, fee-for-service contract negotiations, it’s no wonder that the healthcare industry has grown too comfortable pitting payers and providers against each other.
The lack of trust and transparency between the two groups has led to a perceived misalignment of vision. Across the board, the administrative staff has shouldered the brunt of this friction, which in the end
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Medicaid | Medicaid Patients | Medicaid Reform | Regulation, Policy, Analysis, Insights - HIT Consultant
Aledade Acquires Curia, Adds More Than 450 New Practices
What You Should Know:
- Aledade today announced the acquisition of Curia, a leader in value-based care analytics using practical applications of artificial intelligence (AI) to optimize the targeting of patient care and engagement programs. The acquisition will enhance Aledade’s ability to extract valuable insights from disparate data sources, provide more accurate predictions using past data, and optimize primary care workflows through cutting-edge AI algorithms.
- In addition, the
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Targeted IT Solutions Ease Navigation and Shift to Value-Based Care
The new healthcare realm of value-based care (VBC), designed to reward healthcare providers with incentive payments for the quality of care and patient outcomes not simply the volume of services provided, presents both opportunities and challenges for all stakeholders. This fundamental shift in reimbursement is intended to become part of the larger quality strategy in reforming how healthcare is delivered and compensated: better care for individuals, better health for populations
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CMS Program Integrity’s Role in Combatting FWA While Maintaining Health Equity
In 2022, the Center for Medicare and Medicaid Services (CMS) established health equity as a pillar of its future work. Program integrity staff from every state Medicaid program, and federal program staff working on Medicare, must consider the roles of both program integrity and analytics when combatting fraud, waste, and abuse (FWA)in the healthcare system.
CMS defines health equity as "the attainment of the highest level of health for all people, where everyone has a fair and just
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Why It’s Time for Intelligent Prior Authorization
The Centers for Medicare & Medicaid Services (CMS) recently proposed a new rule to advance interoperability and improve the prior authorization (PA) process for Medicare and Medicaid patients. Specifically, the rule stipulates that health plans adopt electronic prior authorization processes, adhere to shorter turnaround times, clearly communicate denial reasons, publish key metrics annually, and implement the Fast Healthcare Interoperability Resources (FHIR) Application Programming Interface
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FHIR Adoption and Implementation Challenges
The Fast Healthcare Interoperability Resources (FHIR) standard was introduced by HL7 in 2014 as a significant replacement for the HL7 V2 and V3 standards. An open standard called FHIR, which was initially drafted in 2011 makes it easier than ever for legacy systems and new apps to exchange data. FHIR was created to not only increase communication efficiency and interoperability compared to earlier standards but also to facilitate implementation by giving clear specifications and allowing
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Biden Admin Builds on Cancer Moonshot with 13 More Initiatives
What You Should Know:
- One year ago, President Joe Biden and First Lady Jill Biden reignited the Cancer Moonshot, setting an ambitious, achievable goal: to reduce the death rate from cancer by at least 50 percent over the next 25 years, and improve the experience of people and families living with and surviving cancer, ultimately ending cancer as we know it today.
- The Cancer Moonshot has spurred tremendous action across the federal government and from the public and private
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Opioid Use Disorders Cost U.S. Hospitals More than $95B Annually
What You Should Know:
- Based on prevalence estimates from PINC AI™ data during 2017-2022, an estimated 66 million emergency department (ED) outpatient visits and 760,000 inpatient admissions in the U.S. annually are for patients with the diagnosis of opioid use disorders (OUDs).
- Patients with an OUD diagnosis had 32.5 percent higher cost per ED visit and 8 percent higher cost per inpatient visit than those without an OUD diagnosis. The annual total cost of care for OUD-associated ED
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Edifecs and VirtualHealth Partner to Automate Prior Authorization
What You Should Know:
- Today, Edifecs and VirtualHealth, a medical management company, announced a new partnership automated prior authorization to VirtualHealth’s HELIOS® platform for healthcare payer and provider clients.
- The Edifecs solution will automate and optimize the prior authorization process across HELIOS to significantly reduce the administrative burden, alleviate friction between payers and providers, and ultimately expedite patient care.
Growing Need for Automated Prior
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Prisma Health Moves to the Innovaccer Health Cloud
What You Should Know:
- South Carolina’s largest health system, Prisma Health selects the Innovaccer Health Cloud to be its primary value-based care platform for analytics, workflow, and Snowflake data platform management.
- With the Innovaccer Health Cloud’s data and analytics platform, Prisma Health can integrate disparate EHRs and other healthcare systems to create a unified patient record.
Primsa Health Background
Prisma Health provides healthcare services to nearly
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