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

Change Healthcare: Applying AI Could Identify Up to 35% of Denials Prior to Submission

by Fred Pennic 06/24/2019 Leave a Comment

Change Healthcare Claims Lifecycle AI Could Identify Up to 35% of Denials Prior to Submission

Change Healthcare AI can help providers identify problem claims and prevent denials before they happen, avoiding costly rework, delays, and improving revenue flow.Today Change Healthcare announced that it has applied its Claims Lifecycle Artificial Intelligence (AI) technology to its claims management suite with the introduction of Assurance Reimbursement Management™ Denial Propensity Scoring and Revenue Performance Advisor Denial Prevention. With performance enhanced by Claims Lifecycle AI,
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Improving Patient/Member Satisfaction through Nurse Triage Services

by Austin Ridgeway, Director of Sales/Business Development for the Healthcare Vertical at HGS 06/24/2019 Leave a Comment

Improving Patient/Member Satisfaction through Nurse Triage Services

Not long ago, viewed members as captive audiences (more or less). Most members obtained their health insurance through their employers or another group and were unlikely to go outside of that option no matter how they actually felt about the health payer. Providers had to be a little more careful since it was easier to change hospitals or doctors, but even then most patients were willing to unquestioningly accept a low level of service as part of the package of obtaining quality healthcare. Not
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3 Ways Health Plans Can Leverage Lab Data Analytics

by Hossein Fakhrai-Rad, Founder & President at BaseHealth 06/17/2019 Leave a Comment

3 Ways Health Plans Can Leverage Lab Data Analytics

Payers have long realized the value of leveraging disparate data sets to gain greater insight on patients, with popular data sources including claims, electronic health records, and surveys on social determinants and behavioral health. More recently, health plans have begun to appreciate another source of data that can help them avoid missed revenues, predict emerging conditions and improve risk management: laboratory data. This category includes data on critical health factors such as
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Allscripts Acquires Prescription & Prior Authorization Platform ZappRx

by Jasmine Pennic 06/14/2019 Leave a Comment

Allscripts Acquires Prescription & Prior Authorization Platform ZappRx

EHR vendor Allscripts has reached an agreement to acquire prescription and prior authorization platform ZappRx, according to CNBC. The acquisition will help Allscripts diversify its business outside of electronic medical record (EHR). The company has raised a total of $40M in funding to date.Founded in 2012 by Zoe Barry who previously worked at athenahealth, ZappRx streamlines the complex process required to order specialty medications, increasing efficiencies when collecting and maintaining the
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Telegenomics Company Genome Medical Nabs $23M to Bring Genomic Medicine to Everyday Care

by Fred Pennic 06/12/2019 Leave a Comment

Genome Medical

Genome Medical, a leading nationwide telegenomics company providing genomic-based medicine, today announced that it has raised $23 million in Series B financing to accelerate the development of its technology and medical services which support patients, physicians and healthcare systems in all 50 states. The Series B round was led by Echo Health Ventures, a strategic collaboration of Cambia Health Solutions and Mosaic Health Solutions with additional new investors LRVHealth, Casdin
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Humana Integrates Real-Time Benefits Tool with Epic’s E-prescribing Workflow

by Fred Pennic 06/11/2019 Leave a Comment

Humana Integrates Real-Time Benefits Tool with Epic’s E-prescribing Workflow

Humana and Epic today announced an agreement to integrate Humana’s IntelligentRX real-time benefits tool directly into Epic’s e-prescribing workflow. Humana is the first national insurer to collaborate with Epic to bring together patients, providers and payers to power value-based care. The resulting integration will deliver real-time pharmacy data and access to patient’s medical history, which, in turn, will enable cost reduction, improved quality, and increased patient
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Mothers in the U.S. Are Dying: What Are We Doing to Save Them?

by Juan Pablo Segura, Co-founder of Babyscripts 06/06/2019 Leave a Comment

Digital Health - Is It Worth It? How to Calculate ROI in Digital Health

The maternal mortality rate in the United States is the highest of any developed country – and the rate is rising. The US is currently the most dangerous place to give birth in the developed world. Few to none of these maternal deaths are due to medical mismanagement. Instead, problems of access, care coordination, and inequities in health care resources and social services are at the heart of maternal death rates. Minority women, particularly those facing socioeconomic challenges, are the
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Innovaccer, Launches InAPI to Aggregate Healthcare Data for Providers, Payers, and Vendors

by Jasmine Pennic 06/03/2019 Leave a Comment

Innovaccer, Launches InAPI to Aggregate Healthcare Data for Providers, Payers, and Vendors

Healthcare organizations are riding the wave of digital disruption with increased adoption of applications to power patient centric-care, communications, and collaboration with peer organizations in the network. With this objective, they are seeking to integrate crucial information across the care continuum and establish interoperability among complex and disparate data systems- including legacy systems.Existing Interoperability ChallengesThere are over 200 EHRs in the US healthcare space,
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Apprio Launches New Revenue Cycle Management Division , ApprioHealth

by Jasmine Pennic 06/03/2019 Leave a Comment

Apprio Launches New Revenue Cycle Management Division , ApprioHealth

Apprio, a provider of specialized technology solutions for the health, defense, and homeland security markets, today announced it has created ApprioHealth, a new, commercially focused business unit focused on the revenue cycle management requirements of hospitals and health systems. ApprioHealth will be led by Donny Zamora who will serve as the division’s president.ApprioHealth OverviewApprioHealth will deliver services and advanced technology solutions tailored for health organizations’ revenue
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Data-Driven Precision Medicine Startup Tempus Lands $200M to Expand Into New Therapeutic Areas

by Fred Pennic 05/30/2019 Leave a Comment

Data-Driven Precision Medicine Startup Tempus Lands $200M to Expand Into New Therapeutic Areas

Tempus, a leading technology company advancing precision medicine through the collection and analysis of molecular and clinical data, announced today an additional $200M financing at a value of $3.1 billion dollars. The investors include Baillie Gifford, Franklin Templeton, NEA, Novo Holdings, Revolution Growth, and funds and accounts managed by T. Rowe Price. With this latest round, the company has raised $520 million since its founding in September 2015.Founded in 2015, Tempus has the largest
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