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
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Medicare Advantage | Payers | News, Analysis, Insights
The No Surprises Act: How Payers Can Stay Compliant
As the healthcare system continues to evolve to adopt a more patient-centric approach, surprise billing has become a topic discussed by consumers and policymakers. Surprise billing can occur when a patient unknowingly receives care from providers that are outside their network. This can result in balance billing, the practice of billing a patient the difference between what their health plan covers and what the provider charges. Unfortunately, these bills are often the result of care provided in
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Aledade Raises $123M to Expand Value-Based Primary Care
What You Should Know: - Aledade, a Bethesda, MD-based provider of value-based primary care raises $123M in Series E funding to support investments in value-based care for more seniors covered by Medicare Advantage (MA) and innovation that improves patient care and increases medical cost savings, including expanded offerings through its new health services subsidiary, Aledade Care Solutions (ACS). Returning investor OMERS Growth Equity led the round, which also included Fidelity Management
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Rural Provider Homeward Forms In-Market Partnership with Rite Aid to Support Seniors in Underserved Communities
What You Should Know: - Homeward, the comprehensive rural care provider network launched by former Livongo titan, Dr. Jenny Schneider, has announced a partnership with Rite Aid to deliver onsite care to rural Americans, starting with Medicare. - Homeward’s work with Rite Aid will also support the pharmacy retailer’s recently announced plans to double-down on pharmacy services, with increased focus on expansion in underserved communities. This is also Rite Aid’s first push to bring real
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CareMax Acquires Steward Health’s Medicare Value-Based Care Business for $25M
What You Should Know: - CareMax, a tech-enabled provider of value-based care to seniors announced an agreement to acquire the Medicare value-based care business of Steward Health Care System for a combination of cash and stock. - CareMax will pay $25 million in cash and issue 23.5 million shares of CareMax’s Class A common stock to the equity holders of Steward at closing, subject to customary adjustments. In addition, CareMax will fund a Medicare receivable to Steward covering accounts
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KAID Health Raises $4.25M for AI-Powered Provider/Payer Whole Chart Analysis Platform
What You Should Know: KAID Health,makers of anartificial intelligence-enabled clinical analysis and provider engagement platform,today announced its $4.25M in Series A funding bringing their total capital raised to $6.45M. - The funding will fuel growth of the provider/payer platform that integrates with the electronic medical records (EMR) to identify high-value tactical care and coding interventions. The company will also expand its Boston, MA office and will hire new team
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Olive Partners with Magenta to Revolutionize Risk Adjustment Process
What You Should Know: - Olive, the automation company creating the Internet of Healthcare, today announced its partnership with Magenta Care Continuum, a HIPAA-compliant health records vault that includes care gap analytics. - Through the Olive Library, payers and providers can access Magenta's solutions to help close care gaps, improve billing and claims occurrence and ensure compliance and revenue integrity for value-based population management. Automating the Risk
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COVID-19 Fell Out of Top 5 Telehealth Diagnoses Nationwide in February 2022
What You Should Know: - After two months in the top five telehealth diagnoses nationally and in every US census region, COVID-19 fell out of that ranking nationally and in every region in February 2022, according to FAIR Health's Monthly Telehealth Regional Tracker. - The change coincided with a sharp decline in new cases of COVID-19, as reported by the Centers for Disease Control and Prevention, following the January
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3 Senior Living Providers Merge to Form Curana Health
What You Should Know: - Three leading organizations that provide healthcare services to senior living communities – Elite Patient Care, Provider Health Services, and AllyAlign Health – have joined forces to form Curana Health. Curana Health’s mission is to improve the health, happiness, and dignity of senior living residents. The Curana Health ACO is a value-based care program for original Medicare beneficiaries. - The combined Curana Health organization spans 26 states and over 1000+
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Raising Clinical Outcomes and Engagement Through Healthcare Equity: What Health Plans Need to Know
Structural racism and poverty are correlated with a higher incidence of obesity among Black Americans (49%). Social drivers of health, which impact a disproportionate number of non-white Americans who live below the poverty line, account for as much as 90% of individuals’ health outcomes. These are just two examples of data that highlight the need for equity. Health plans are well-aware that shifting this dynamic and boosting clinical outcomes is possible through better,
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