What You Should Know: In recent years, the complex payer claims and administration market has seen several changes. Historically, payers have used multiple technology vendors and homegrown tools to meet their broad functionality needs. Now, payers are looking to consolidate platforms to improve efficiency and their ability to manage multiple business lines.As finding a platform that meets payers’ complex needs can be challenging, a new report by KLAS provides a comprehensive look at
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Payers| Payer Industry Impact for Patients, Clinicians, and Healthcare Organizations | News, Analysis, Insights - HIT Consultant
FWA Is Increasing. Healthcare Costs Are Spiraling. Now There’s A New Generation Of AI Technology To Take Back Control
In 2020, the Department of Justice estimated that fraudulent, wasteful, and abusive (FWA) billing practices account for more than $100 billion of the nation’s healthcare expenditures.1 Today, the National Healthcare Anti-Fraud Association (NHCAA) conservatively estimates that healthcare FWA costs the nation about $68 billion annually, representing 3% of the nation's $2.26 trillion in healthcare spending.2 FWA estimates from commercial health plans range as high as $230 billion annually, or
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Healthcare Considerations: Addressing Cyber Risk in the Healthcare Industry
In 2020, the Dental Care Alliance (DCA) experienced a significant cyberattack on its systems, which lasted approximately an entire month. This gave the threat actor an extended period to compromise the healthcare organization’s servers and extract the private and confidential information of around one million patients. This is just another example of how vulnerable the healthcare industry is to cyber criminals looking to exploit security weaknesses. Healthcare organizations are prime targets
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Improving Non-Emergency Medical Transportation: Driving Better Outcomes for Patients and Health Plans
As the healthcare industry continues to evolve, there is a growing need for innovative solutions that not only improve the quality of care but also make care more accessible. Non-emergency medical transportation (NEMT) plays a crucial role in helping patients get to where care is delivered. As healthcare reform efforts continue to gain momentum, transportation benefits have become an increasingly critical component of providing equitable care to patients. NEMT helps close the health equity gap
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10 Critical KPIs Every Successful Healthcare Organization is Implementing
Contract Logix white paper reveals the top 10 most important contract management KPIs and how to maximize their impact It's critical for every healthcare organization to monitor and optimize its contracts and contracting processes using key performance indicators (KPIs). But how do you determine which KPIs are the most important to your business and how do you harness the data required to benchmark and track them? By benchmarking and tracking these KPIs in your healthcare organization, you
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5 Digital Health Executives Share Their Key Takeaways from HIMSS23
John Erwin, CEO of Carenet Health I was pleased with the robust turnout at HIMSS this year; it does seem like the healthcare industry is making up for the lost time from the pandemic. The topics that dominated the conference included teasing out the nuanced approach to safely deploying Chat GPT/AI into the industry (and when not to), health equity, and the patient journey. Workforce burnout continues to be a major issue in healthcare, though I think we could have
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Risk Adjustment 2023: Which Vendors Drive Value in a Shifting Market?
What You Should Know: Strategies employed by payers, provider-sponsored health plans, and provider organizations are starting to become more proactive, and the need for solutions with prospective, predictive capabilities is rising. Additionally, amid rising healthcare costs and economic uncertainty, organizations are looking for solutions that deliver more for less.A new KLAS report examines risk adjustment vendors’ abilities to drive outcomes and value, their prospective capabilities,
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1upHealth Raises $40M for FHR Data Platform
What You Should Know: 1upHealth, a modern data platform that’s cloud-based, API-enabled, and FHIR-native today announced the close of a $40M Series C investment led by Sixth Street Growth with participation from existing investors F-Prime Capital, Jackson Square Ventures, and Eniac Ventures. Founded in 2017, 1upHealth’s FHIR®-native platform designed for interoperability and modern computing is used by over 75 enterprise organizations including leading national and
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MedArrive Secures $8M to Expand At-Home Care
What You Should Know: - MedArrive, a Mobile-integrated care management platform company today announced $8M in new funding led by Cobalt Ventures, a wholly owned subsidiary of Blue Cross and Blue Shield of Kansas City (Blue KC). The investment follows MedArrive’s $25 million series A round in November 2021 and brings the company’s total funding to $40.5M to date - MedArrive plans to use the new investment to expand its payer relationships, build out its team and
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Availity Acquires Olive AI’s Utilization Management Solution and Business Unit
What You Should Know: - Availity today announced a definitive agreement to acquire the utilization management solution and business unit from healthcare automation company Olive AI, Inc. Financial details of the acquisition were not disclosed. - The acquisition of Olive AI's utilization management solution offers numerous benefits for Availity’s national network of payers and providers. These include lower administrative and medical costs, improved patient access
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