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
Utilization Management
Why Health Plans Must Have Next-Gen CAPS Technology for Digital Transformation
Core Administrative Processing Systems (CAPS) operate as the brains behind a health plan’s business. These systems are critical to the smooth functioning of a health plan. Today, many payers run on decades-old CAPS systems built on legacy technologies. This can be a serious drawback.
Legacy systems may have been efficient based on the technology and best practices of decades past, but have aged beyond their time. They often require an increasing number of workarounds and fixes to try to
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
XSOLIS Raises $75M for AI-Driven Precision Utilization Management Platform
What You Should Know:
- XSOLIS, a healthcare technology firm focused on improving healthcare operations announced it has raised $75M in minority growth investment from Brighton Park Capital ("Brighton Park"), a research-driven investment firm.
- XSOLIS is an artificial intelligence-based software platform that helps national health systems and payers streamline the utilization management process.
- XSOLIS' suite of data-driven solutions leverages insights from proprietary machine
Read More
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
Read More
COVID-19: How Can Payers Prepare for Mandates and Support Pandemic Relief Efforts
Healthcare can achieve optimum efficiency when patients are at the center of care. When patients have the necessary information to navigate their care journey, they will choose the path to high-quality care at the lowest costs. Cost-sharing and insurance premiums are rising consistently since the last decade for employer plans, which covers nearly half of the country’s population. Plan members are shouldering a part of the healthcare cost burden, so they want to keep it as low as possible. At
Read More
Addressing Social Determinants of Health: IT Solutions to Engage Community Resources
What You Should Know:
- The latest report from Chilmark Research examines the
new approaches and tools for utilizing community resources that can address
social determinants of health, giving providers the ability to extend care
beyond the confines of the clinic.
- This research indicates that the next two years will largely bring an expansion of product capabilities with slow and steady growth in implementation as the market better defines key variables and sets standards for
Read More
Predictive Analytics: Preventing the Aftershocks from COVID-19
Right now, the world’s attention is focused on COVID-19. This is most appropriate as it has hit the world like a global earthquake, disrupting lives on an unprecedented scale.
However, there will come a day when the immediate danger has passed. At that point, it’s very likely that the healthcare system will begin to feel the significant aftershocks of COVID-19 in the form of neglected chronic condition management throughout the pandemic.
The Centers for Disease Control
Read More
The New Normal: Rethinking Healthcare Delivery in a Post-COVID World
It’s becoming clearer that, while we are all hoping that things are going to go back to the way things were at the beginning of the year, the COVID-19 crisis will result in a new normal. That’s especially true in healthcare, due to four issues that are being wildly amplified by the COVID-19 crisis. Namely:
1. The US government has huge deficits, and healthcare is a major driver of the unsustainable increase in these deficits.
2. Addressing the demand for healthcare as a right (not a
Read More
COVID-19 Crisis Makes Complying with Data Interoperability a Priority
With healthcare organizations focused on battling COVID-19, the recent federal healthcare regulation requiring data interoperability may have become an afterthought. However, compliance with this rule will create a powerful tool for fighting COVID-19 recurrences and future pandemics.
If interoperability had gone into effect earlier this year as originally scheduled, many insurance companies and the federal government would now be able to securely share the data they have for most of the
Read More
