Achieving fluid data interoperability has been a complex and challenging goal for the U.S. healthcare system. The result of which has led to excessive administrative costs, delays in providing care, and significant patient frustration.
According to the Centers for Medicare and Medicaid Services, U.S. healthcare spending grew 9.7% in 2020, reaching $4.1 trillion, or $12,530 per person. This is forecasted to grow to $6.2 trillion by 2028, which will only exacerbate the current spending
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Payers| Payer Industry Impact for Patients, Clinicians, and Healthcare Organizations | News, Analysis, Insights - HIT Consultant
The No Surprises Act: How Payers Can Stay Compliant
As the healthcare system continues to evolve to adopt a more patient-centric approach, surprise billing has become a topic discussed by consumers and policymakers. Surprise billing can occur when a patient unknowingly receives care from providers that are outside their network. This can result in balance billing, the practice of billing a patient the difference between what their health plan covers and what the provider charges. Unfortunately, these bills are often the result of care provided in
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Aledade Raises $123M to Expand Value-Based Primary Care
What You Should Know:
- Aledade, a Bethesda, MD-based provider of value-based primary care raises $123M in Series E funding to support investments in value-based care for more seniors covered by Medicare Advantage (MA) and innovation that improves patient care and increases medical cost savings, including expanded offerings through its new health services subsidiary, Aledade Care Solutions (ACS). Returning investor OMERS Growth Equity led the round, which also included Fidelity Management
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Why Health Plans Must Have Next-Gen CAPS Technology for Digital Transformation
Core Administrative Processing Systems (CAPS) operate as the brains behind a health plan’s business. These systems are critical to the smooth functioning of a health plan. Today, many payers run on decades-old CAPS systems built on legacy technologies. This can be a serious drawback.
Legacy systems may have been efficient based on the technology and best practices of decades past, but have aged beyond their time. They often require an increasing number of workarounds and fixes to try to
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Lightbeam Health Acquires Jvion AI and SDOH Solutions – M&A
What You Should Know:
– Lightbeam Health Solutions, Inc., a provider of population health management solutions and services has entered into an asset purchase agreement to acquire the operating assets related to Jvion, Inc., including Jvion’s market-leading AI-enabled prescriptive analytics and social determinants of health (SDoH) solutions.
-The strategic partnership combines Lightbeam’s health analytics and outcomes for payers and providers with the Jvion’s predictive technology.
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Phenomix Sciences Launches Obesity Biobanking Registry Studying Personalized Treatment Options Based on Genetics
What You Should Know:
- Biotech company Phenomix Sciences launches its biobanking registry, marking the first obesity registry to study the impact of personalized treatment based on phenotyping. The impact of this biobanking registry and the data it will yield has the potential to change the entire system’s approach to obesity, from a treatment recommendation to the way payers determine coverage and how the industry combines diagnostics testing with drug therapy.
- The
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Komodo Health Appoints COO, Transcarent, Vytalize Health, RxBenefits, Other Digital Health Appointments
Komodo Health has named Dr. Aswin Chandrakantan as its Chief Operating Officer. Dr. Chandrakantan will also continue to serve as the firm’s Chief Medical Officer, a role he has held since 2016. Dr. Chandrakantan was one of Komodo Health’s earliest employees – following leadership roles at McKinsey and Google – and has played a central role in the company’s rapid-fire growth.
RxBenefits appoints Wendy Barnes as its new Chief Executive Officer. Barnes succeeds Bryan Statham, who served as the
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KAID Health Raises $4.25M for AI-Powered Provider/Payer Whole Chart Analysis Platform
What You Should Know:
KAID Health,makers of anartificial intelligence-enabled clinical analysis and provider engagement platform,today announced its $4.25M in Series A funding bringing their total capital raised to $6.45M.
- The funding will fuel growth of the provider/payer platform that integrates with the electronic medical records (EMR) to identify high-value tactical care and coding interventions. The company will also expand its Boston, MA office and will hire new team
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Olive Partners with Magenta to Revolutionize Risk Adjustment Process
What You Should Know:
- Olive, the automation company creating the Internet of Healthcare, today announced its partnership with Magenta Care Continuum, a HIPAA-compliant health records vault that includes care gap analytics.
- Through the Olive Library, payers and providers can access Magenta's solutions to help close care gaps, improve billing and claims occurrence and ensure compliance and revenue integrity for value-based population management.
Automating the Risk
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Polygon to Partner with MSP on Healthcare Blockchain Initiative
What You Should Know:
- Today, Polygon Networks, a leading blockchain and scaling solution, announced a partnership with Tokenology and MSP Recovery to deliver LifeChain - a new healthcare claims platform.
- LifeChain will leverage blockchain technology to solve healthcare's biggest problems, including fraud, inefficiency in payments and antiquated processes.
Tokenize Healthcare Claims On-Chain
LifeChain will be developed by MSP Recovery and Tokenology as a fully tokenized Medicare,
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