The saying “you cannot manage what you cannot measure” applies to all aspects of healthcare delivery, but it is especially true in value-based care. After all, payers, providers, and the patients they care for need to know what high-value care looks like at an individual level – and how it can be applied at the population level.
Delivery and technology infrastructure. All too often, data is captured in disparate systems, forcing administrative staff – or, worse, physicians and nurses – to
Read More
Prior Authorization
Top Job Stressors for Pharmacist and Prescribers, Exacerbated by Incomplete Patient Data
What You Should Know:
- Survey data released by Surescripts, a health information network, showed that two-thirds (65%) of specialty prescribers and almost three-quarters (73%) of specialty pharmacists agree that the leading cause of delays in getting patients started on their specialty medications is due to issues often caused by outdated processes and paperwork required for prior authorization.
- The survey, taken this summer by 501 specialty pharmacists and prescribers of specialty
Read More
Edifecs Launches Solution to Automate Prior Authorization at the Point of Care
What You Should Know:
- The full automation of prior authorization at the point of care leads to improved member experiences, enhanced outcomes, ongoing compliance, and reduced administrative burden. Edifecs’ automated prior authorization solution integrates with electronic health records (EHR) and leverages artificial intelligence (AI), natural language processing (NLP), and industry standards such as FHIR to instantly deliver authorization.
- This innovation comes on the heels of
Read More
Pharmacogenomics: The Key to Unlocking the Future of Personalized Healthcare
Pharmacogenomics—the study of genetic influences on an individual's response to therapeutic medications—is an area of personalized medicine that is gaining momentum. Although pharmacogenomics has been around for a while, providers, health plans, pharmacists and legislators are developing a greater appreciation for its potential benefits and applications.
How Can Pharmacogenomics Improve Outcomes?
By considering a person’s DNA in treatment options, providers can determine how an
Read More
Executive Roundtable: Can Innovation Alleviate Clinician Burnout?
The U.S. Surgeon General’s recent advisory about clinician burnout cited numerous societal, cultural, structural, and organizational causes—including excessive workloads, administrative burden, and lack of organizational support. The potential fallout of this trajectory is alarming: The advisory cites the Association of American Medical Colleges’ estimate on clinician demand outpacing supply, with an anticipated shortage of between
Read More
Geisinger Taps Cohere Health to Streamline Prior Authorizations
What You Should Know:
- Today Geisinger Health Plan (GHP) and Cohere Health, a provider of utilization management (UM) technology, announced they are joining forces to streamline the prior authorization process for providers.
- Cohere’s collaborative UM platform will help GHP support value-based care delivery, reduce administrative costs, and lead the nation in aligning quality improvement initiatives across all its lines of business, including
Read More
Capital Rx Raises $106M to End Drug Price Distortion
What You Should Know:
- Capital Rx, a health technology company changing the way prescription drugs are priced and patients are serviced raises $106M in a Series C round to end drug price distortion. The Series C round was led by B Capital with participation from General Catalyst and existing investors, Transformation Capital and Edison Partners, bringing the total amount raised to $175M.
- Capital Rx will continue to invest in the technology backbone for claims processing and benefit
Read More
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
Read More
Free Market Health Secures $13.5M for Advance Specialty Pharmacy Ecosystem
What You Should Know:
Free Market Health, a Pittsburgh-based healthcare technology company transforming the specialty pharmacy ecosystem with a care-driven marketplace platform, today announced its $13.5M in Series A financing led by Alta Partners and with participation from existing investors Highmark Ventures and 653 Investment Partners.
- The capital will enable the company’s team of specialty pharmacy industry experts to scale beyond the hundreds of millions of dollars in specialty
Read More
GuideWell Becomes First U.S. Payer to Automate Prior Authorizations
What You Should Know:
- GuideWell, one of the 10 largest health insurance providers in the U.S., became the first U.S. payer to automate prior authorization approvals through AI-powered clinical reviews from Olive, resulting in faster care for patients — up to 10 days faster — and greater provider satisfaction.
- After launching a pilot with Olive in Florida, GuideWell saw its time to decision reduced by 10 days when immediate responses were available, decreased unnecessary prior
Read More
