What You Should Know: - Ribbon Health, an API data platform for the healthcare industry that powers care decisions, and Turquoise Health, a provider of structured data on the cost of care to make pricing data both transparent and accessible to patients, announced an integration partnership. - By integrating Turquoise Health's price transparency data into the Ribbon Health platform, healthcare companies will be able to effectively navigate patients to cost-effective and high-quality
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Payers| Payer Industry Impact for Patients, Clinicians, and Healthcare Organizations | News, Analysis, Insights - HIT Consultant
3 Ways Health Plans Can Improve Sleep Health for their Members
Getting a good night’s sleep should have nothing to do with having a great health plan — but it often does. While some individuals can improve their sleep by making small changes, many who suffer from serious, chronic sleep disorders need a higher level of care and ongoing treatments, and many health plans offer insufficient benefits. For example, Medicare covers sleep diagnostic tests under strict conditions, if patients are referred by a physician. Other health plans have denied
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Breaking Down the Implications of New No Surprises Act Regulations
The importance of the No Surprises Act (NSA) cannot be overstated, as surprise medical bills have long been burdensome for patients in the U.S. healthcare system. In fact, more than half of all U.S. consumers have received an unexpectedly large medical bills. The purpose of the No Surprises Act is to prevent surprise out-of-network bills, often for emergency services. For example, if your appendix bursts while at work, you would be rushed to the nearest hospital for an emergency
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Unlocking Interoperability with a Blockchain-Powered Network
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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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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