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CMS Has Changed the Game for Medicare Advantage Reimbursement. Here’s How Plans Can Respond Effectively.Jeremy Berk, senior vice president of Risk Adjustment Solutions for PopHealthCare and Emcara Health, shares how plans must conduct a detailed analysis of how changes to risk adjustment models impact your plan in order to set an effective go-forward strategy.
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How Will the End of the CMS Submission Deadline Extension Affect Your Risk Adjustment Program?With the Centers for Medicare & Medicaid Services extension on claims submissions coming to an end in 2024, health plans must separate fact from fiction around proactive risk adjustment to confidently submit claims for accurate reimbursement.
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Let’s Stop Talking About Interoperability and Just Make it WorkInteroperability was theme at the Healthcare Information and Management Systems Society (HIMSS) meeting last week in Chicago. How can all that talk and aspiration be turned into action?
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To Drive Value-Based Healthcare, We Must First Redefine ItThe healthcare industry needs to better align with consumers around this notion and their broader perception of what constitutes value.
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What Shifting U.S. Demographics Mean for Health PlansThe country is becoming more diverse. Health plans need to adapt by making their provider networks as diverse as possible and committing to diversity in their management ranks.
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Reproductive Privacy Rights: Changes Coming for Healthcare OrganizationsThe Office of Civil Rights published a proposed rule that could have healthcare organizations evaluating their practices surrounding, and interactions with, reproductive healthcare information.
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Profits of Publicly Traded Health Plans Surge Amid Requests for Higher RatesAmid struggling providers, furloughs of essential workers, years of premium increases and record high earnings, for-profit health plans should consider options for directly helping their networks.
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Dismantling Stigmas: How to Stop the Blame Game and Get Patients the Care they NeedThere is a bias in this country against people whose medical condition is perceived to be “their fault”– in other words, the result of their own lifestyle choices. To combat stigma and its harmful effects, there needs to be broader understanding, even among medical professionals.
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The ‘Healthy Immigrant Effect’ Is Alive and Well in Kidney Disease, Study FindsPrevious research has found that immigrants have lower rates of heart disease, diabetes, dementia and other chronic health conditions compared with nonimmigrants. A new study adds kidney disease to the list.
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Healthcare Trends to Watch in 2023Healthcare will continue its evolution toward value-based reimbursement models in 2023 as provider organizations, commercial payers and government programs seek more ways to improve health outcomes while reducing costs.
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Health Plan CIOs: Essential Elements for SuccessThe technology infrastructure of many health plans today could be described as costly, fragmented and siloed. Rather than focusing on the customer experience, growth and transformation, these plans are responding reactively to business needs and market shifts.
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Joe Biden Wants to Cure Cancer. Here’s Where to StartDeposing the ‘Emperor of All Maladies’ will take a diverse toolkit, not a single moonshot.
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Expanding the Use of CGP in Screening and SurgeryClosing out his discussion on CGP, David Gandara, MD, looks toward future opportunities for CGP in screening patients before or after surgery.
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Why 50/50 Gender Representation Matters in HealthcareWhen women are underrepresented in healthcare — half of our world’s population becomes at-risk.
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What Payers Need to Know As Retail Pharmacies Move Into Primary CareHealthcare beyond the doors of the doctor’s office has the potential to offer more care to more people. But payers need to think about how to ensure that care is consistent. Regardless of the setting, care decisions must be based on evidence-based content and supported with strong patient education.
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Advancing Healthcare Innovation through AI AdoptionLeading health providers are implementing AI to improve patient and staff safety and quality, allowing them to accomplish their technological innovation goals for better use of resources, with higher satisfaction.
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HIPAA Compliance in the Age of COVID-19Now is the time for compliance officers to get a better grasp on compliance and continuity across the organization.
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Maximizing Impact Through Strategic Research Investments That Address Unmet NeedsPatient organizations should focus on how they can be the most effective by leveraging their strengths to uncover new research opportunities.
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3 Ways to Reach Your Care Coordination and Communication GoalsIn this second part of a two-part article series, Curtis Gattis, CEO and co-founder of LeadingReach, discusses how healthcare organizations participating in risk-based contracting or value-based financial and care delivery models are currently facing major challenges with integrating, managing and tracking care coordination and communication capabilities within provider networks.
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Why Social Determinants of Health Are a Critical Factor for Preventing Member Risk Escalation in the Value-Based Care EquationMedicaid managed care organization (MCOs) may be better equipped to address social determinants of health (SDOH) and health equity than payers who use fee-for-service models because SDOH are central to many requirements for MCOs, including those pertaining to population health management, health equity and care coordination.
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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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The Explosion in Genetic Testing — and How To Manage ItPayers must be early adopters of managing genetic testing through DEX Z-Codes, combined with science-based policies and policy adherence and claims editing technology.
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Future Modalities for InfertilityLucy van de Wiel, PhD, discusses how emerging technologies such as in vitro gametogenesis and gene editing show promise for addressing complex infertility cases, potentially revolutionizing reproductive medicine by offering new solutions for patients with genetic disorders, same-sex couples, and those with uterine factor infertility.
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7 Skills Healthcare Executives Need to SucceedThe COVID-19 pandemic has tested every healthcare executive’s ability to adjust — and adjust again. From mid-March through summer and now early fall, the ups and downs of the outbreak have occurred at a furious, unpredictable cadence.
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Keys to Effective Remote Patient Monitoring in the COVID-19 PandemicHealth organizations that had RPM solutions in place pre-pandemic have been more successful at scaling up than organizations that were starting from scratch during the pandemic.
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Now More Than Ever We Should Take Advantage of the Transformational Benefits of AI and ML in HealthcareArtificial intelligence and machine learning can take on simple tasks in healthcare so people can focus on collaboration and work on a higher cognitive level.
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The Future of Idiopathic and Progressive Pulmonary Fibrosis TreatmentAn expert physician discusses the potential role of novel agents in the management of idiopathic and progressive pulmonary fibrosis.
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Government Agencies Using AI to Detect Healthcare FraudHere’s what you need to know and do considering the DOJ’s and HHS’s drastically expanded use of digital tools to investigate and prosecute those who work in the field of healthcare, including innocent practices and providers.
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Health Plan CIOs: Essential Elements for SuccessThe technology infrastructure of many health plans today could be described as costly, fragmented and siloed. Rather than focusing on the customer experience, growth and transformation, these plans are responding reactively to business needs and market shifts.
