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

Smile Digital Health Closes $30M to Expand Health Data Fabric Platform

by Fred Pennic 01/27/2023 Leave a Comment

Smile Digital Health Closes $30M to Expand Health Data Fabric Platform

What You Should Know: - Smile CDR Inc. (doing business as Smile Digital Health) ("Smile"), a FHIR® health data fabric (HDF) and exchange solutions provider raises $30M in Series B growth capital led by existing investors including UPMC Enterprises.  - Founded in 2016, Smile's HDF platform uses industry-leading HDF architecture and ONC-compliant, event-driven FHIR APIs to allow healthcare providers, payers and IT vendors to build secure,
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Study: Increased Transparency Between Payers and Providers at the Point-of-Care Improves Risk Capture and Quality Measures

by Syed Hamza Sohail 01/25/2023 Leave a Comment

Study: Increased Transparency Between Payers and Providers at the Point-of-Care Improves Risk Capture and Quality Measures

What You Should Know: - IllumiCare, a pioneer in point-of-care healthcare information technology, today released a new report detailing how increased data transparency between health plans and providers on care and coding gaps results in higher compliance, process improvement, and positive behavior changes among network providers.  - The report demonstrates, across multiple plans, that placing previously unavailable yet actionable information on quality gaps, HCC (Hierarchical
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Healthcare Profit Pools to Reach $790B by 2026, Report Reveals

by Syed Hamza Sohail 01/24/2023 Leave a Comment

Healthcare Profit Pools to Reach $790B by 2026, Report Reveals

What You Should Know: - Healthcare profit pools are expected to grow 4 percent annually resulting from $654 billion in 2021 to $790 billion in 2026, according to a new McKinsey report. - The report reveals inflation is not transitory and the economic outlook has meaningfully darkened due to a healthcare worker shortage and endemic COVID-19.   What to expect in US healthcare in 2023 and beyond The US healthcare industry faces demanding conditions in 2023, including
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9 Executive Revenue Cycle Predictions/Trends to Watch in 2023

by Fred Pennic 01/23/2023 Leave a Comment

Executive Revenue Cycle Predictions/Trends

Nate Maslak, the co-founder/CEO of Ribbon Health Price Transparency: In 2022, we saw CMS’s Transparency in Coverage rule go into effect, requiring non-hospital entities like health plans and providers to publish publicly available rates for care. In 2023, we’ll see this price transparency data become more mainstream as it finally makes its way into the hands of patients, empowering them to find the best care for them, reevaluate their care choices, and shop around for the best possible care
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How Will The Inflation Reduction Act Impact Healthcare in 2023? 6 Trends to Know

by Syed Hamza Sohail 01/23/2023 Leave a Comment

How Will The Inflation Reduction Act Impact Healthcare in 2023? 6 Trends to Know

What You Should Know: - As the world prepares for the Inflation Reduction Act’s landmark policy changes, healthcare stakeholders realize that its wide-ranging effects will require new approaches to drug pricing, health plan design, and investment. - Avalere’s ‘2023 Healthcare Industry Outlook’ examines how community-wide healthcare will be affected by a recent court ruling, and consider data’s role in addressing health disparities. Key Trends in Healthcare in 2023 The main insights
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8 Executive Key Takeaways from JP Morgan Healthcare Conference

by Fred Pennic 01/20/2023 Leave a Comment

8 Executive Key Takeaways from JP Morgan Healthcare Conference

Mike Serbinis, CEO of League JPMorgan was buzzing this year. Part of that is post-Covid return to conference excitement. Part of that is the fact that healthcare has never been more important. While the economy was challenged in 2022, investors are ready to do business in healthcare. The stakes are getting higher and the opportunity in front of us is massive. Pete Anevski, CEO of Progyny People who are currently struggling with infertility, and those who are looking to start or expand
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The Health Data Interoperability Highway Is Coming. Is Your Organization Ready?

by Lee Barrett, Commission Executive Director of DirectTrust 01/20/2023 Leave a Comment

health data The Interoperability Highway Is Coming. Is Your Organization Ready?

Not many of us remember a time when there weren’t interstates widely available to help us get to where we need to go. Winding roads and sleepy towns can be nostalgic, but they’re not great time savers when time is of the essence. At a macro level, The Trusted Exchange Framework and Common Agreement (TEFCA) promises to be the interoperability superhighway for healthcare data, speeding information on patients from care facility and care provider — regardless of location or healthcare entity —
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Medical Natural Language Processing Tech Has Come of Age

by Dr. Tim O’Connell, Founder & CEO of emtelligent 01/19/2023 Leave a Comment

Medical Natural Language Processing Tech Has Come of Age

For many years, natural language processing (NLP) has held the promise of dramatically increasing the ability of healthcare organizations to quickly and accurately understand unstructured medical text in clinical notes. Using medical NLP, healthcare providers, clinical researchers, and payers would uncover meaningful insights hidden in unstructured text faster, with fewer errors, and at less cost than manual data review and analysis. This high-quality medical-grade data in turn would drive
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8 Executive Pharmacy Predictions/Trends to Watch in 2023

by Fred Pennic 01/18/2023 Leave a Comment

Executive Pharmacy Predictions/Trends 2023

Frank Harvey, CEO at Surescripts Community pharmacists trusted to deliver care: In 2023, pharmacists will play an integral role as part of the team managing patient care for diseases like diabetes, hypertension, or multiple comorbidities. And to support this work, I predict that we will see more activity between payers, pharmacists, the government and technology organizations to ensure that pharmacists are able to perform these important activities and be reimbursed for their work. Greg
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Unlocking Patient Medical Records Through Digital Retrieval of Clinical Data

by Beth Zuehlke, Chief Customer Officer at Moxe Health 01/18/2023 Leave a Comment

Unlocking Patient Medical Records Through Digital Retrieval of Clinical Data

Thousands of times a day, at health systems throughout the US, workers manually search for patient medical charts, print them out on paper, or save them to a file—and then fax, mail, or email them to a payer or third party who has requested it. The productivity for this often manual approach is about five charts an hour per worker, and the average cost to retrieve a medical record varies by state, health system, and the number of pages. The cost per medical record ranges from about $25 to
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