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Medicare Advantage | Payers | News, Analysis, Insights

Healthcare’s Uncertain Future: 3 Data-Driven Approaches for Payers

by Emad Rizk, M.D., President, CEO & Chairman of the Board, Cotiviti 06/27/2019 Leave a Comment

Navigating Healthcare’s Uncertain Future: Three Data-Driven Approaches for Payers

Nine out of 10 healthcare leaders expect disruptive pressures to increase tremendously in the year ahead, according to a recent survey. However, fewer than half believe their organizations are prepared to withstand these forces. In an era of transformation—in which traditional business models are continually being revamped in response to pressures such as consumerism, policy changes, and the market entrance of non-traditional healthcare players such as Amazon and Apple—payers face daunting
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AdhereHealth And Papa Partner to Tackle Social Determinants of Health

by Fred Pennic 06/25/2019 Leave a Comment

Stryker, RCSI Partner to Develop Digital Health Solutions for Emergency & Specialist Care Blue Cross Blue Shield Institute Launches Program to Address Social Determinants of Health at The Community Level

AdhereHealth, a healthcare technology company focused on medication adherence, announced a partnership with Papa, a companionship platform company serving the elderly, blind and disabled. AdhereHealth and Papa will work together to address social determinants of health such as loneliness, food insecurity, and transportation to improve health outcomes for Medicare beneficiaries. The partnership addresses these foundational barriers to care through a combination of advanced technologies and
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3 Ways Health Plans Can Leverage Lab Data Analytics

by Hossein Fakhrai-Rad, Founder & President at BaseHealth 06/17/2019 Leave a Comment

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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Survey: 83% of Consumers Are Interested in Receiving Virtual Care, But Only 17% Have Access To It

by Fred Pennic 05/22/2019 Leave a Comment

Xerox: 61% of Americans Open to Receiving Virtual Care

Virtual care received an essential boost in November 2018 when CMS Administrator Seema Verma addressed the Alliance for Connected Care Telehealth Policy Forum for Health Systems. Verma told the audience, "Telehealth is changing the very face of healthcare.” This shift is apparent in the behaviors of healthcare consumers. While consumers may love the idea of virtual care, a new study shows few are taking advantage of it.Patients Hungry for Virtual CareThat’s the core message coming out of a
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5 Ways Health Plans Can Motivate Medicare & Medicaid Members to Complete Their Annual Wellness Visits

by Eileen Cianciolo, Chief Product Officer at NovuHealth 05/13/2019 Leave a Comment

5 Ways Health Plans Can Motivate Medicare & Medicaid Members to Complete Their Annual Wellness Visits

Despite the fact that Annual Wellness Visits (AWVs) have been offered as a benefit to Medicare Advantage and Medicaid members for several years, less than one in five members actually receive one. That number is even more surprising when you consider just how important AWVs can be for health plans, providers, and most importantly, consumers. For example, Medicare Advantage members who complete an AWV are 4.2 times more likely on average to complete other high-value health care activities, such
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DispatchHealth Nabs $33M to Expand On-Demand Healthcare Model to High Acuity Patients

by Jasmine Pennic 05/07/2019 Leave a Comment

Philips, Dispatch Health Launch On-Demand Home Care Pilot Program for Arizona Seniors

DispatchHealth (formerly known as True North Health Navigation), a Denver, CO-based provider of on-demand healthcare delivery to a patient’s home has raised $33 million in growth capital funding led by Echo Health Ventures, a strategic collaboration of Cambia Health Solutions and Mosaic Health Solutions. The funding also included participation from existing investors Alta Partners, Questa Capital and additional strategic investors.Founded in 2013 by two mobile health executives, DispatchHealth’s
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Vericred Launches Medicare Advantage API to Support Insur Tech & Digital Health Companies

by Fred Pennic 05/06/2019 Leave a Comment

Vericred Launches Medicare Advantage API to Support Insur Tech & Digital Health Companies

Vericred, an NYC-based data services platform powering the digital distribution of health insurance and employee benefits, announced today a Medicare Advantage rating API enabling InsurTech and digital health companies to build innovative solutions that serve the fast-growing Medicare-eligible population.Growth of Medicare Advantage PlansMedicare Advantage – also known as Medicare Part C – is a program in which individuals who qualify for Medicare enroll in certified health plans offered by
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CMS Approves Livongo As An Enrolled Provider for Medicare Advantage Members

by Fred Pennic 04/30/2019 Leave a Comment

CMS Approves Livongo As An Enrolled Provider for Medicare Advantage Members

Livongo, the leading Applied Health Signals company announced that it has been approved by the Centers for Medicare and Medicaid Services (CMS) as an enrolled provider for Medicare Advantage members. In addition, starting in June, the Livongo for Diabetes program will be available to Medicare Advantage members of Cambia Health Solutions' regional health plans.Empowering America's Senior PopulationCambia reaches nearly 70 million Americans nationwide, including more than two million people in the
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Cardiogram’s Wearable Based Monitoring Tool Is Now Covered by Oscar

by Fred Pennic 04/26/2019 Leave a Comment

Cardiogram’s Wearable Based Monitoring Tool Is Now Covered by Insurer Oscar

Cardiogram is a digital health company announced that it's wearable-based monitoring for atrial fibrillation and diabetes is now covered by Oscar Health Insurance, without paying out of pocket. The coverage will help provide end-to-end preventive care: continuous wearable monitoring, convenient testing, contextualized results, and clinical triage.Impact of Chronic ConditionsFor chronic conditions like diabetes, atrial fibrillation, hypertension, and sleep apnea, anywhere between 20–80% of cases
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AllyAlign Health Raises $10M to Power Value-Based Care for Seniors

by Fred Pennic 04/17/2019 Leave a Comment

AllyAlign Health Raises $10M to Power Value-Based Care for Seniors

AllyAlign Health, a Richmond-based developer and administrator of Medicare Advantage special need plans that benefit long-term care providers has raised $10M in strategic funding led by McKesson Ventures. Existing investors Heritage Healthcare Innovation Fund, Health Enterprise Partners and the LinkAge Fund also participated in the financing. This brings the total capital raised to over $41 million.AllyAlign Health BackgroundAllyAlign Health (AAH) began reforming the health system in 2014 by
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