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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Prior Authorization
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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How Times of Crisis Spur Needed Change in Healthcare Delivery
As the COVID-19 pandemic continues to change healthcare operations in the world, foundational systems are being adapted to meet these new demands. Sometimes it takes extreme circumstances to see the cracks in a system. COVID-19 has exposed areas with more room for improvement in the healthcare system, such as optimizing operational efficiency. Organizations and individuals have changed their interactions, processes, ways of working, treatment plans, and even foundational technology. As the
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Cohere Health Launches with $10M to Increase Transparency Across Care Journey
What You Should Know:
- Boston-based health IT start-up Cohere Health announced the official launch of its company with a $10 million Series A funding round led by Flare Capital Partners.
- The company’s patient journey-focused platform improves the notoriously difficult prior authorization process and replaces an existing patchwork of legacy, siloed processes, and antiquated technologies that contribute to the enormous administrative burden for physicians and health plans.
- The end
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4 Ways Healthcare Organizations Can Establish Partnerships to Drive Innovation
With public and private healthcare spending significantly outpacing that of other countries, U.S. hospitals face intense pressure to find new ways to capture greater value. More and more, organizations are finding that partnerships with existing vendors can help unlock next-level performance gains in a transformative environment.
Take Nebraska Medicine, for example. In the early 2000s, the health system created multidisciplinary committees to boost revenue integrity and adopted new revenue
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Why Outsourcing is the Best Approach to Prior Authorizations
Doctors didn’t attend medical school to spend their waking hours managing or waiting for prior authorizations (PA), but these days it feels like that’s all they are doing.
A recent American Medical Association survey found that 90 percent of responding physicians believe that the “administrative burden related to PA requests has risen in the last five years, with most saying it has ‘increased significantly.’” As healthcare continues its acceleration toward value-based reimbursement models,
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