Medicare’s annual enrollment period has started, and you know what that means: a slew of commercials suddenly appearing on television for Medicare Advantage plans.
The advertising appears to be working. Enrollment in Medicare Advantage has more than doubled over the past decade to more than 26 million people this year. The private health plans, which are an alternative to traditional Medicare, account for 42% of the total Medicare population.
The growth of Medicare Advantage, though, has
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Prior Authorization
Cohere Health, Humana Expand Partnership to Transform Prior Authorization Process
What You Should Know:
- Cohere Health announced that Humana Inc. is embarking on a nationwide expansion of Cohere's digital prior authorization platform for musculoskeletal (MSK) services, based on the success of its initial implementation.
- After rolling out the platform across 12 states in January 2021, Humana has made significant progress toward achieving its vision to reimagine and modernize processes for prior authorization by reducing approval times, increasing provider
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Banjo Health Lands $5M for AI-Driven Prior Authorization Platform
What You Should Know:
- Banjo Health, a Washington-based provider of AI-driven prior authorization ("PA") solutions, announced today it has raised in excess of $5 million in Series A financing led by Epsilon Health Investors, with participation from Spark Growth Ventures and Tau Ventures. Epsilon Health Investors Co-Founder and General Partner, Gregory Epstein, will be joining Banjo Health's Board of Directors.
- Banjo Health is focused on bringing transparency and automation to PA through
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Cohere Health Raises $36M to Automate Prior Authorization Between Payers & Providers
What You Should Know:
- Boston-based health IT company Cohere Health has closed a $36 million Series B funding round led by Polaris Partners, with additional participation from new investors Longitude Capital and Deerfield Management, as well as existing investors Flare Capital Partners and Define Ventures. The round comes less than a year after the company launched, and only 3 months after a Series A extension.
- Cohere Health’s AI-based, fully
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Healthcare Can Save $16.3B Automating Administrative Transactions, Report Finds
What You Should Know:
- Each year, the US healthcare industry spends $39 billion on 9 administrative transactions, according to a new report from CAQH.
- The 2020 CAQH Index also uncovered that by automating these transactions, the industry could save $16.3 billion annually--a 42% cost reduction.
CAQH, released the eighth annual report measuring the progress made by healthcare payers and providers in automating administrative transactions. The 2020 CAQH Index found that, of
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How Automation is Key to the Future of Healthcare Operations
As the saying goes, necessity is the mother of invention. A similar correlation is seen in the quest to leverage innovation and out-of-the-box thinking to address key problems facing the healthcare industry. The ongoing COVID-19 pandemic has brought the immense pressure the U.S. healthcare system is under into sharp focus. Recent dynamics are compounded by the industry’s efforts to adopt newer ways of working and digitizing patient records, while implementing automation throughout their business
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20 COVID-19 Predictions and Trends for 2021 – Executive Roundup
Dr. Justin Graham, Chief Medical Officer, GYANT
The rapid development of a COVID-19 vaccine is a monumental achievement, but it does nothing to address our extremely fragmented healthcare system. In 2021, policymakers must create and extend incentives to providers to work together to keep patients healthy rather than maximize profit. The pandemic has devastated the traditional fee-for-service budgets of many healthcare systems, and it isn't clear they will ever be able to catch up without
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M&A: Olive Acquires AI Prior Authorization Company Verata Health
What You Should Know:
- On the heels of $225.5 million dollars in funding and a
$1.5B valuation this week, Olive today announced its acquisition of Verata
Health to create a combined AI prior authorization solution for providers and
payers under the Olive name.
- Prior authorization is a $31 billion dollar issue in
healthcare, and one of the top reasons patient care is delayed. Olive is now
able to reduce write-offs by over 40% and cut turnaround times for prior
authorizations by up to
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Humana Taps Cohere Health to Modernize Prior Authorizations for Musculoskeletal Treatment
What You Should Know:
- Cohere Health partners with health insurer Humana to modernize
the prior authorization process for musculoskeletal treatment across 12 states.
- In addition, the company has closed an additional $10M
in funding led by Flare Capital Partners and Define Venture, bringing the
company’s total funding to $20M.
Health insurer Humana has signed an agreement with healthcare collaboration company Cohere Health to improve the prior authorization process for
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Waystar Acquires Medicare RCM Company eSolutions at $1.3B Valuation
What You Should Know:
- Revenue cycle management provider Waystar acquires eSolutions, a provider of Medicare and Multi-Payer revenue cycle management, workflow automation, and data analytics tools at a $1.3B valuation.
- The acquisition will create the first unified
healthcare payments platform with both commercial and government payer
connectivity, resulting in greater value for providers.
Waystar, a provider of healthcare payments software, today
announced a definitive agreement
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