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Payers| Payer Industry Impact for Patients, Clinicians, and Healthcare Organizations | News, Analysis, Insights - HIT Consultant

Modernizing Medicare Advantage Translations: How AI Streamlines Compliance for Health Payers

by Patrick Kehoe, Executive Vice President of Product Management, Messagepoint, Inc. 09/05/2025 Leave a Comment

Modernizing Medicare Advantage Translations: How AI Streamlines Compliance for Health Payers

For healthcare payers offering Medicare Advantage and Dual Special Needs Plans (D-SNPs), the translation of member-facing materials is a costly, complex and high-stakes process. Translation requirements place an enormous burden on payers and, yet, it is critical for a positive member experience and accessibility in the U.S., where nearly 68 million people speak a language other than English at home. The Centers for Medicare & Medicaid Services (CMS) mandates that materials such as Annual
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KLAS: Cognizant & HealthEdge Leads Market for Payer Claims & Administration Platforms

by Syed Hamza Sohail 08/28/2023 Leave a Comment

KLAS: Cognizant & HealthEdge Leads Marker for Payer Claims & Administration Platforms

What You Should Know: In recent years, the complex payer claims and administration market has seen several changes. Historically, payers have used multiple technology vendors and homegrown tools to meet their broad functionality needs. Now, payers are looking to consolidate platforms to improve efficiency and their ability to manage multiple business lines.As finding a platform that meets payers’ complex needs can be challenging, a new report by KLAS provides a comprehensive look at
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FWA Is Increasing. Healthcare Costs Are Spiraling. Now There’s A New Generation Of AI Technology To Take Back Control

by Theja Birur, Chief Technology Officer & Founder, 4L Data Intelligence 05/12/2023 Leave a Comment

FWA Is Increasing. Healthcare Costs Are Spiraling. Now There’s A New Generation Of AI Technology To Take Back Control

In 2020, the Department of Justice estimated that fraudulent, wasteful, and abusive (FWA) billing practices account for more than $100 billion of the nation’s healthcare expenditures.1 Today, the National Healthcare Anti-Fraud Association (NHCAA) conservatively estimates that healthcare FWA costs the nation about $68 billion annually, representing 3% of the nation's $2.26 trillion in healthcare spending.2  FWA estimates from commercial health plans range as high as $230 billion annually, or
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Healthcare Considerations: Addressing Cyber Risk in the Healthcare Industry

by Bryan Smith, Chief Technology Officer, RiskLens 05/10/2023 Leave a Comment

Healthcare Considerations: Addressing Cyber Risk in the Healthcare Industry

In 2020, the Dental Care Alliance (DCA) experienced a significant cyberattack on its systems, which lasted approximately an entire month. This gave the threat actor an extended period to compromise the healthcare organization’s servers and extract the private and confidential information of around one million patients.  This is just another example of how vulnerable the healthcare industry is to cyber criminals looking to exploit security weaknesses. Healthcare organizations are prime targets
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Improving Non-Emergency Medical Transportation: Driving Better Outcomes for Patients and Health Plans

by Andy Auerbach, Chief Revenue Officer of SafeRide Health 05/02/2023 Leave a Comment

Improving Non-Emergency Medical Transportation: Driving Better Outcomes for Patients and Health Plans

As the healthcare industry continues to evolve, there is a growing need for innovative solutions that not only improve the quality of care but also make care more accessible. Non-emergency medical transportation (NEMT) plays a crucial role in helping patients get to where care is delivered. As healthcare reform efforts continue to gain momentum, transportation benefits have become an increasingly critical component of providing equitable care to patients. NEMT helps close the health equity gap
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10 Critical KPIs Every Successful Healthcare Organization is Implementing

by HIT Consultant Knowledge Hub 04/28/2023 Leave a Comment

10 Critical KPIs Every Successful Healthcare Organization is Implementing

Contract Logix white paper reveals the top 10 most important contract management KPIs and how to maximize their impact It's critical for every healthcare organization to monitor and optimize its contracts and contracting processes using key performance indicators (KPIs). But how do you determine which KPIs are the most important to your business and how do you harness the data required to benchmark and track them? By benchmarking and tracking these KPIs in your healthcare organization, you
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5 Digital Health Executives Share Their Key Takeaways from HIMSS23

by Fred Pennic 04/27/2023 Leave a Comment

HIMSS23 Executive Takeaways

John Erwin, CEO of Carenet Health I was pleased with the robust turnout at HIMSS this year; it does seem like the healthcare industry is making up for the lost time from the pandemic. The topics that dominated the conference included teasing out the nuanced approach to safely deploying Chat GPT/AI into the industry (and when not to), health equity, and the patient journey. Workforce burnout continues to be a major issue in healthcare, though I think we could have
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Risk Adjustment 2023: Which Vendors Drive Value in a Shifting Market?

by Syed Hamza Sohail 04/12/2023 Leave a Comment

Risk Adjustment 2023: Which Vendors Drive Value in a Shifting Market?

What You Should Know: Strategies employed by payers, provider-sponsored health plans, and provider organizations are starting to become more proactive, and the need for solutions with prospective, predictive capabilities is rising. Additionally, amid rising healthcare costs and economic uncertainty, organizations are looking for solutions that deliver more for less.A new KLAS report examines risk adjustment vendors’ abilities to drive outcomes and value, their prospective capabilities,
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1upHealth Raises $40M for FHR Data Platform

by Fred Pennic 04/12/2023 Leave a Comment

1upHealth Raises $40M for FHR Data Platform

What You Should Know: 1upHealth, a modern data platform that’s cloud-based, API-enabled, and FHIR-native today announced the close of a $40M Series C investment led by Sixth Street Growth with participation from existing investors F-Prime Capital, Jackson Square Ventures, and Eniac Ventures. Founded in 2017, 1upHealth’s FHIR®-native platform designed for interoperability and modern computing is used by over 75 enterprise organizations including leading national and
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MedArrive Secures $8M to Expand At-Home Care

by Digital Health Funding 04/11/2023 Leave a Comment

Bright Health, MedArrive Partner to Deliver Preventative In-Home Care

What You Should Know: - MedArrive, a Mobile-integrated care management platform company today announced $8M in new funding led by Cobalt Ventures, a wholly owned subsidiary of Blue Cross and Blue Shield of Kansas City (Blue KC). The investment follows MedArrive’s $25 million series A round in November 2021 and brings the company’s total funding to $40.5M to date - MedArrive plans to use the new investment to expand its payer relationships, build out its team and
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