Mark Martin, Director of Payer Solutions for Availity
Value-based healthcare demands meaningful payer-provider collaboration. However, burdensome administrative processes and inefficient solutions stunt the ability of payers and providers to share data, manage risk, validate credentials, process claims, control costs and optimize the consumer experience.
These information bottlenecks are most acute in the area of provider data management (PDM). Each year, payers and providers spend more than
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Medicare Advantage | Payers | News, Analysis, Insights
Bright Health Lands $635M to Expand Medicare Advantage Plans to More Markets
- Bright Health, a diversified consumer-focused healthcare company announced it has raised $635M in Series D funding led by NEA. - The funding will be used to support Bright Health's aggressive growth and hiring as the company continues to strategically expand across products, geographies and consumer bases.- With this round, Bright Health has raised over a billion dollars in equity financing since early 2016, reaching "unicorn status" with a valuation of over $1B. Bright Health, a diversified
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Philips, Humana Partner on 2 Pilot Programs to Improve Care for At-Risk Medicare Advantage Members
- Philips and Human collaborate on new pilot programs designed to help support independent living for at-risk Medicare Advantage members by providing 24/7 access to care. - Humana is identifying a pilot group of members with severe CHF. Philips is providing members with kits that include an interactive tablet that syncs data from connected measurement devices via wireless technology. - Humana is identifying members who are at-risk and offering them Philips Lifeline medical alert service,
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Humana, Epione Health Form Value-Based Care Agreement for Humana Medicare Advantage Members
- Humana and Epione Health team up to offer a patient-centered experience for Humana Medicare Advantage members in Oklahoma. - Humana Medicare Advantage HMO and PPO plan patients will benefit from this relationship as the support offered by Humana enables Epione’s doctors to focus on patient care.Humana Inc., today announced it has collaborated with Epione Health of Oklahoma, LLC on a value-based care agreement designed to offer a coordinated, patient-centered experience to help Humana Medicare
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Can Consumer Price Transparency in Healthcare Live Up to the Hype?
There has been a lot of discussion in recent weeks and months about price transparency in healthcare. The idea is simple—payers and providers reveal the rates they pay or charge for health services in order to help consumers make better choices.
Despite the hype surrounding price transparency, it will undoubtedly come with a whole set of realities and limitations—there are a variety of factors that go into setting prices, and in many cases, the prices that get posted don’t reflect the price
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HMS Holdings Corp to Acquire Payment Accuracy Company Accent for $155M
- HMS Holdings Corp acquires Accent, a payment accuracy, and cost containment business from Intrado Corporation for approximately $155 million.- Accent’s offerings include comprehensive prospective and retrospective claims accuracy solutions, which incorporates both cost avoidance and overpayment recovery services.- Addition of service provider to commercial and Medicare Advantage health plans to expand the breadth of HMS’ prospective and retrospective claims accuracy services.HMS Holdings Corp.
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Inaccurate Provider Directories Costs Physician Practices $2.76B Annually
- Providers spend $2.76 billion each year on provider directory maintenance, a new survey by CAQH found. - For individual practices, this intensive process costs $998.84 per month--the equivalent of one staff day per week. That is time and money that most providers can't afford to waste.- CAQH surveyed 1,240 physician practices last month and just released "TheHidden Causes of Inaccurate Provider Directories"-- a new white paper that details the burdens the survey uncovered and what the industry
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Disruptors or Interrupters? How Apple Is Faring In Their Healthcare Initiatives
Key Highlights
- Part one of our new in-depth series on Apple, Google, and Amazon's latest healthcare efforts since our last report in April 2019.
- A look at Apple's recent healthcare developments, as well as an analysis of what goes beyond the news.
Over the last few decades the “digital age” has enabled many garage-based startups to transform into sustained successes by targeting problems that begged to be solved digitally. Sometimes their leaders identified and resolved
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How Value-Based Care is Changing the Way You Build Digital Health Companies
After years of talk, fee-for-service payment models are finally being challenged in a real way. With value-based care, providers are reimbursed based on patient health outcomes rather than the number of patients they see, which has begun to pass the burden of cost from insurers and employers to providers and patients.
Fundamentally, value-based care requires vendors as well as providers to operate differently, but new revenue models and a new approach to hiring deserve special consideration. In
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N.J. Physician Group ACO Generates $6.4M in Medicare Savings
- Partners In Care ACO generated $6.4M in savings and is among top 3 performers statewide under Medicare Shared Savings Program in New Jersey. - While providing high-quality care for patients, Medicare is sharing a portion of these savings with the providers in return.Partners In Care Accountable Care Organization (ACO) generated $6.4 million in savings – an average of $546 per Medicare patient – in 2018. The savings are tracked by the Centers for Medicare and Medicaid Services (CMS), under the
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