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
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Prior Authorization
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
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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
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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
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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
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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
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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
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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
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Prior Authorizations: 3 Ways to Reduce Administrative Burden & Burnout
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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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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