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

22 Executive Digital Health Predictions to Watch in 2023

by Fred Pennic 01/16/2023 Leave a Comment

22 Executive Digital Health Predictions to Watch in 2023

Jon Bloom, MD, CEO and Co-founder of Podimetrics From a digital health perspective, 2022 was a reset year for many and a serious reality check. We went from sky high growth to the sky is falling, and in 2023 I think this market correction movement will continue forward. To me, the biggest surprise of 2022 was that despite the market tanking, digital health companies continued to truck forward with huge deals. This includes massive acquisitions like Amazon and OneMedical, as well as deals like
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Study Reveals Current Landscape of FHIR Apps

by Syed Hamza Sohail 01/16/2023 Leave a Comment

Study Reveals Current Landscape of FHIR Apps

What You Should Know: - A study led by Regenstrief Institute Research Scientist Titus K. Schleyer, DMD, PhD, is among the first to survey the current landscape of FHIR® apps, providing a snapshot of how the innovative standard is used to enable the flow of health information - FHIR apps can pull in data from most electronic health record systems, facilitating secure movement of information when and where needed. Expanding the Horizon of Patient Data Security Via FHIR Apps FHIR,
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The Important Role of Community Pharmacy in 2023

by Lindsay Dymowski, President at Centennial Pharmacy Services 01/13/2023 Leave a Comment

The Important Role of Community Pharmacy in 2023

The healthcare landscape continues to shift as we emerge from an uncertain and continuously-evolving pandemic. Technology is playing a vital role in giving people access to necessary services and, as a part of this technology shift, community pharmacies are stepping up in order to better serve the public.  Pharmacies in America were once little more than glorified convenience stores, where one could pick up anything from dishwashing detergent to a Twix bar (and stop and get their
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Healthcare Payment Integrity: Insourcing vs. Outsourcing

by Steve Lang, Senior Vice President, SyTrue 01/13/2023 Leave a Comment

Healthcare Payment Integrity: Insourcing vs. Outsourcing

Faced with shifting regulations, growing administrative complexity, high-dollar claims, and the looming potential of audits, payment integrity is an increasingly important priority for payers. Payers realize that when they make the correct payments to providers initially, they increase trust, reduce provider abrasion, and lower appeal rates. Traditionally, many health plans have outsourced payment integrity work to vendors who perform reviews, and then return the results to those health
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Edifecs and 3M Partner on Integrated Value-Based Payment Solution

by Jasmine Pennic 01/11/2023 Leave a Comment

ICD-10 Impact on Cash Flow_EHR Implementations

What You Should Know: - 3M Health Information Systems and Edifecs (a global health IT solutions provider) announced a collaboration and new unique solution for providers and payers that will accelerate the adoption of value-based payment (VBP) models. - A new, combined solution that will overcome barriers that have previously prevented rapid adoption of VBP models. This advanced approach will allow payers and providers to quantify the value of preventing negative events and allocate
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Digital Health Funding Reaches $15.3B in 2022 Across 572 Deals, Rock Health Reports

by Syed Hamza Sohail 01/10/2023 Leave a Comment

Digital Health Funding Reaches $15.3B in 2022 Across 572 Deals, Rock Health Reports

What You Should Know: - In a downtrodden market climate, things don’t need to feel doom and gloom, according to Rock Health’s Annual 2022 digital health funding report. 2022 was a necessary reminder that investment is cyclical and that strong players build resilience in weathering funding climate changes. - Analysts expect that 2023 will be built up on slow, steady, and maybe even boring strategies for healthcare startups and enterprises alike: managing cash, restructuring to accommodate
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6 Executive Health Data Predictions to Watch in 2023

by Fred Pennic 01/09/2023 Leave a Comment

6 Executive Health Data Predictions to Watch in 2023

Kevin Agatstein, CEO at Kaid Health In 2023 I predict that unstructured medical data, which makes up the majority of a patient’s chart, will become too valuable to ignore by both providers and payers. Driven in part by the growth of Medicare Advantage and oncology, both of which require the data within medical notes rather than just claims and labs data, organizations will start to use their unstructured EMR data in entirely new ways. Rob Cohen, CEO at Bamboo Health In today’s
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Real-World Data Startup Crescendo Health Launches with $3.2M

by Fred Pennic 01/06/2023 Leave a Comment

Real-World Data Startup Crescendo Health Launches with $3.2M

What You Should Know: - Crescendo Health, a real-world data startup that's drastically reshaping how clinical researchers get access to hard-to-reach patient data to support their clinical research today officially announced its launch with $3.4M in seed funding from Define Ventures as well as the founders and CEOs of many other well-known organizations. - Founded by the co-founder of Datavant (merged with Ciox in a $7 billion deal), and a top product-management leader from Grand
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The Patient Journey Tech Stack: 10 Pharma Predictions for 2023

by Yishai Knobel, Co-Founder & CEO of RxWare 01/05/2023 Leave a Comment

The Patient Journey Tech Stack: 10 Pharma Predictions for 2023

The complexity of demands on Market Access teams has increased in recent years, between introducing innovative therapies targeting smaller populations and higher bars from Payers and PBMs.  Now, drug manufacturers are bucking up. According to the IQVIA Institute, the prescription abandonment rate has reached 27 percent, or $76 billion annually, in specialty drugs alone. This squandered revenue has led manufacturers to increase their focus on the complex, nuanced patient journey.  As a
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5 Things to Consider Before Implementing a CAPS System in 2023

by Michele Oliveto-Hill, SVP and GM, Global Professional Services, HealthEdge 01/05/2023 Leave a Comment

5 Things to Consider Before Implementing a CAPS System in 2023

Core administrative processing systems (CAPS) serve as the center of the healthcare payer architecture and are essential for efficient business operations. These systems are needed to support administrative and transactional processing and are a significant investment in technology. Selecting a CAPS system isn’t a single purchase, but rather an ongoing partnership that requires maintenance to ensure the system remains up to date to support industry and regulatory changes. Last year, 99% of
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