Today, cancer is the second leading cause of death in the United States. Sadly, cancer disparities exist, with racial/ethnic minority, low-income, and uninsured populations suffering the greatest burden. That’s why routine cancer screening is critical to addressing cancer disparities as they have the potential to greatly reduce both incidence and mortality rates. To address this, Federally qualified health centers (FQHCs) are funded by the Health Resources and Services Administration to provide
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Medicare Insurance| Regulatory, Policy, Patients Analysis, Insights - HIT Consultant
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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Upstream Healthcare Selects Innovaccer to Scale Value-Based Care Model Nationwide
What You Should Know: - Innovaccer Inc. announced that UpStream Healthcare, one of the fastest-growing value-based primary healthcare provider solutions in the country, has entered into a multi-year partnership agreement to more than double its population on Innovaccer’s cloud-native platform over the next year, and will use it to scale UpStream’s unique value-based care model nationwide. - The expanded relationship between the two companies comes on the heels of UpStream’s recent $140
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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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