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Advanced Analytics: an Essential Tool for Value-Based Care SuccessData analytics allows providers to gain insights from performance management measures and metrics that hold the clues to financial viability under risk-based and pay-for-performance contracts. By embracing advanced analytics, hospitals and health systems can accelerate their path to value.
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Artificial Intelligence Saves Payers Time and MoneyArtificial intelligence can help deal with everyday problems such as prior authorization and high utilization. But payers are also eyeing it for loftier purposes.
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Why Telehealth and Continuous Remote Patient Monitoring Has Staying Power Beyond COVID-19Telehealth solutions are here to stay.
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While We Await Vaccine Progress, We Can Trust in Generic DrugsGeneric drugs account for 90% of the prescriptions filled in the United States. They are the backbone of healthcare providers’ treatment protocol and they are remarkably cost effective: despite being 90% of the prescriptions filled, generics account for only 20% of drug spending.
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Future of Wet AMD TreatmentDiana Do, MD, and Steven Peskin, MD, MBA, FACP, discuss unmet needs and future approaches to treatment in wet AMD.
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Considering the Ideal Role for Non-Emergency Medical Transportation in Addressing SDoH in Medicaid and Medicare PopulationsMedicare and Medicaid programs that serve the most-vulnerable Americans facing SDOH barriers can be major facilitators of appropriate non-emergency transportation to non-medical sites. But how do we determine what is appropriate, and what do we know about transportation services to non-medical sites today?
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5 Tips for Employers on Reforming and Optimizing Medication UseLives can be saved, physician burnout and waste can be reduced, and drug costs can decrease by achieving medication optimization through comprehensive medication management.
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Overcoming Cancer’s Financial Toxicity with Real-World DataFinancial Toxicity is a growing concern for many cancer patients and caregivers, and with the continued rise in treatment costs, it can no longer be ignored.
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How AI is Changing the Conversation Around Hospital Denials – and Improving Financial Implications in the ProcessIn an early 2023 brief published by KFF, CMS transparency data for 2021 revealed an average denial rate of 17% for all in-network claims, with authorization denials reported as high as 24% of denial volume for some plans and medical necessity denial rates as high as 37% for others.
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Future of Wet AMD TreatmentDiana Do, MD, and Steven Peskin, MD, MBA, FACP, discuss unmet needs and future approaches to treatment in wet AMD.
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Data Interoperability is Essential to Vaccination SuccessCOVID-19 is not in the rearview mirror. Greater collaboration among organizations, and a new sense of purpose with regard to interoperability, is essential in this new era.
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4 Ways Insurers Can Turn ‘Embarrassment of Profits’ into Solutions that MatterEven as many industries continue to suffer devastating setbacks due to the COVID-19 pandemic, one sector that has enjoyed an “embarrassment of profits” is health insurance.
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Increasing Access to Effective Therapies for Atopic DermatitisCurrent strategies used to evaluate the performance of therapies used to treat atopic dermatitis and guide formulary decisions, and recommendations to help patients receive access to effective therapies.
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High-Impact Measurement for Chronic Conditions Helps Avoid Excess Care CostsAdherence measures developed by the Pharmacy Quality Alliance (PQA) are an important part of the Medicare Part D Star Ratings program. PQA has launched a Health Equity Technical Expert Panel to provide input on specific approaches to ensuring PQA’s measures support equitable health care.
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The How and Why of Enterprisewide Clinical Data Integration StrategyClinical data integration can mean navigating through an obstacle course of organizational and technical challenges. But it can show its ROI bona fides with digital chart review and other efforts.
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Older Women More Prone to C Diff, COVID-19 CoinfectionThose with certain comorbidities, including peptic ulcer disease and renal failure, were at additional risk of developing C diff infection.
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Four Ways Medicare Advantage Plans Can Stay Ahead of OIG Denial ConcernsA recent HHS Office of Inspector General's report found that Medicare Advantage (MA) plans inappropriately deny prior authorization requests. With MA enrollment growing, scrutiny of MA plans and their utilization management strategies is also likely to grow, according to Alina Czekai, M.P.H., of Cohere Health. Czekai argues that artificial intelligence and machine learning can improve utilization management and prevent inappropriate denials.
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Improving Member Perception: How Health Plans Can More Effectively Move the NeedleElevating customer services isn’t enough to raise Star ratings and quality. Payers and their provider partners also need to meet patients at their level.
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Use Quick Wins to Speed Your Healthcare Digital TransformationWhat does it take for a healthcare organization to effectively expedite and achieve a digital transformation? Start with the fundamentals, like having an integrated transformation strategy with clear goals across the enterprise, highly visible and vocal top-down leadership, and exceptional tactical talent for implementation.
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The Evolution and Promise of Preventive Screenings at HomeHome-based testing could be a less expensive way to improve preventive care.
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Closing Gaps in Care: Improving Patient Outcomes and Revenue RecoveryHospitals can't go back to their old ways. They need high-tech, high-touch strategies to engage patients.
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Hospitals Aren’t Investing Enough in the Supply Chain and They’re Paying the PriceA look at the challenges hospitals face due to an insufficient supply chain—and how to address them.
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Automate Your Practice's Workflows with These 5 ToolsTo maintain patient satisfaction and regulatory compliance and reduce potential clerical errors while maintaining high productivity, you can ease your staff’s burdens by automating your practice’s workflows and empower your staff to do more in less time.
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The Future of Employer Sponsored Healthcare Plans Is Cost ManagementAdding tax-preferred savings, perhaps with an employer match, can prompt employees to accumulate assets so they are prepared to shoulder out-of-pocket costs. Using reference-based pricing can establish benchmark fees and put a ceiling on payments across a network.
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How Health Insurers Can Ease the Mental and Emotional Toll of Caregiving for MembersInsurers can assist with navigating the complexities of the healthcare system so caregivers can focus on what matters most — spending quality time with a loved one.
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How Health Insurers Can Create Remarkable Experiences in a Rapidly Changing IndustryThe health industry is changing rapidly, and organizations that don’t adapt are going the way of the Model T. By offering new solutions and capabilities, successful organizations are supporting their customers with whole-person, full-journey care.
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IMPACT’s Pillars to Ensure Your Virtual-First Care Solution Meets Industry StandardsThe potential benefits of a remodeled delivery system based on virtual first care (V1C) are tremendous. Without consistent evaluation criteria to guide builders and buyers towards high-quality V1C, the trust of this movement is at stake.
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How to Put Some Science Behind the Art of Physician ReferralsMedicine is both an art and a science. Some physicians would contend that science—specifically data science—has overtaken medicine and limited their ability to make decisions based on informed intuition and personal experience.
