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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Medicare Advantage | Payers | News, Analysis, Insights
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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HealthTap Launches Eval360 for Health Plans to Expand PCP Care for Members
What You Should Know:
- HealthTap, the leading virtual primary care provider, announced today the official launch of Eval360, an innovative product for health plans that enables HealthTap’s primary care doctors to conduct comprehensive virtual medical evaluations and easily share useful health data back with those partner plans, by providing a 360-degree view of a member’s health status.
- HealthTap completed a successful beta period for Eval360 for over 15,000 seniors through its
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First-Ever Medicare Advantage Plan for LGBTQ+ Older Adults Launches
What You Should Know:
- SCAN Health Plan, a Medicare Advantage insurer known for its expertise in keeping older adults healthy and independent is launching SCAN Affirm partnered with Included LGBTQ+ Health (HMO), a first-of-its-kind Medicare Advantage plan developed exclusively for LGBTQ+ older adults, in collaboration with Included Health, the only integrated virtual care and navigation platform.
- SCAN Health Plan will offer the SCAN Affirm plan to members in
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Digital Fax Solutions Alleviate Administrative Burden and Reduce Costs
At the LeadingAge Illinois 2022 Annual Meeting, Elizabeth McLaren, VP of Reimbursement and Community-Based Services, along with Steven Wermuth, MPA at Strategic Health Care, presented their analysis on the top billing mistakes. What did they find? Within long-term care providers, 8-10% of Medicare Advantage claims were denied. Shockingly, the 10% denial rate impacted revenue by $200 million! They also found that 80% of denied claims are due to missing or incorrect information used during intake
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