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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Medicare Advantage | Payers | News, Analysis, Insights
Mighty Health Raises $7.6M for Daily Health Program for Medicare-Aged Adults
What You Should Know: Mighty Health, the first all-in-one daily health program designed for adults ages 50 and up, today announced $7.6M in new financing co-led by Will Ventures and GFT Ventures. - Mighty Health has built the modern home for healthy living for 50 on up, offering aging adults access to personalized and holistic health guidance through joint-friendly workouts, chronic condition-specific programs, custom nutrition plans, and 1-on-1 health coaching.
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Study: Increased Transparency Between Payers and Providers at the Point-of-Care Improves Risk Capture and Quality Measures
What You Should Know: - IllumiCare, a pioneer in point-of-care healthcare information technology, today released a new report detailing how increased data transparency between health plans and providers on care and coding gaps results in higher compliance, process improvement, and positive behavior changes among network providers. - The report demonstrates, across multiple plans, that placing previously unavailable yet actionable information on quality gaps, HCC (Hierarchical
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9 Executive Revenue Cycle Predictions/Trends to Watch in 2023
Nate Maslak, the co-founder/CEO of Ribbon Health Price Transparency: In 2022, we saw CMS’s Transparency in Coverage rule go into effect, requiring non-hospital entities like health plans and providers to publish publicly available rates for care. In 2023, we’ll see this price transparency data become more mainstream as it finally makes its way into the hands of patients, empowering them to find the best care for them, reevaluate their care choices, and shop around for the best possible care
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6 Executive Health Data Predictions to Watch in 2023
Kevin Agatstein, CEO at Kaid Health In 2023 I predict that unstructured medical data, which makes up the majority of a patient’s chart, will become too valuable to ignore by both providers and payers. Driven in part by the growth of Medicare Advantage and oncology, both of which require the data within medical notes rather than just claims and labs data, organizations will start to use their unstructured EMR data in entirely new ways. Rob Cohen, CEO at Bamboo Health In today’s
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Monogram Health Secures $375M to Expand In-Home Kidney Care
What You Should Know: - Monogram Health, a Nashville, TN-based kidney disease benefit management and care delivery company announced a $375M growth funding round that will drive the company’s continued rapid expansion as the leading solution for high-quality, in-home care for polychronic patients living with chronic kidney and end-stage renal disease in the U.S. - Investors in the round include CVS Health, Cigna, Humana, Memorial Hermann Health System, SCAN, TPG Capital, Frist Cressey
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7 Buy-Side Considerations for Healthcare M&A in 2023
The shift to value-based care and an abundance of cash in the market are some of the drivers impacting healthcare mergers and acquisitions. These and other trends have been strong over the past few months and are expected to continue, impacting transaction planning for buyers. If you are considering acquiring a healthcare business in 2023, here are seven things you need to know. 1. Value-based care is becoming a key driver in healthcare M&A Value-based care
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Backed by Major Health Plans, Carallel Raises $8.2M for Personalized Caregiver Support
What You Should Know: - Carallel, a Chicago, IL-based provider of human-centered guidance and digital tools for family caregivers raises a $8.2M Series A funding round led by FCA Venture Partners, with participation from prominent regional payers including 450 Ventures, as well as Create Health Ventures, Gratitude Railroad, Loud Capital, and Wanxiang Healthcare Investments. - Carallel uses expert guidance and digital tools to identify and empower caregivers so they can confidently
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KLAS: State of Value-Based Care Reimbursement in 2022 Trends
What You Should Know: - Value-based care (VBC) has been established as a priority among healthcare organizations and payers as participants have gained more experience in managing their quality metrics and contracts, ultimately realizing returns on their investments. - For their latest report, Value-Based Care Reimbursement 2022, KLAS talked to 54 healthcare executives—including CEOs, CFOs, CIOs, CMIOs, COOs, VPs and directors of population health, and VPs of analytics—to gauge how
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How Will New FDA Hearing Aid Regulations Impact Health Plans?
The time has finally arrived. The Food & Drug Administration’s new over-the-counter (OTC) hearing aid regulations are now in effect and health plans are starting to explore what it means for them. Among the many questions they may need to grapple with, a few are particularly salient: - How will the new rules impact their benefit offerings? - What new opportunities will arise? - What potential pitfalls should they be aware of? Introducing OTC hearing
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