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Medicaid Redetermination Post-PHE: Navigating the UncertaintyIn this opinion piece, Karen shares some of the critical issues related to re-enrolling members subject to Medicaid redetermination and covers some of the most important critical success factors for organizations seeking to optimize their response.
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Why COVID-19 Has Put Records Management in the Spotlight for Healthcare InsurersAlthough the importance of comprehensive records management programs is not a new phenomenon, over the last few months events surrounding COVID-19 have brought records management into increased focus.
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OSHA's COVID-19 Emergency Temporary Standard: What Healthcare Employers Need to KnowOSHA issued new "emergency temporary standards" for healthcare employers that create new rules for personal protective equipment (PPE), isolation in case of contact and other measures designed to protect workers and patients from COVID-19.
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This New Molecule Could Be Key to Treating Inflammatory Bowel Disease and Atopic DermatitisThe molecule, DPT0218, was detected during preclinical animal trials.
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Unlocking Efficiency: How A Lab Gold Card Program Can Transform Prior AuthorizationGold carding eliminates prior authorization for top-performing labs and eases plan workflows while controlling spending and preventing abuse.
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Time to Bring Clinical Light to Shadowed Women’s Health IssuesThe scientific community has the urgent opportunity to produce more research on the proven health benefits of testosterone and other hormones for women.
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How Innovation in Healthcare Technology Can Help Improve Nursing CultureAmid the nursing shortage, hospitals can create better working conditions through these three technology solutions.
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The Opportunity in CMS’s Price Transparency RuleThe opportunity for health insurers is to implement a well-designed cost estimator tool that goes beyond compliance to the new CMS rule and meets member and health insurer market trends by integrating more quality and cost metrics with an easy-to-use member interface.
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Could the Pandemic Put an End to Medical Overtreatment?COVID-19 pandemic may present an opportunity to hit a reset button on American healthcare that could winnow out unnecessary, wasteful services and prescriptions.
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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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Dialysis Industry Is Now the Most Concentrated in Healthcare, Study Finds, With Prices Far Higher in Monopoly AreasPhysician ownership of facilities and joint ventures with major chains also increased substantially from 2005 to 2019.
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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.
