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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.
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Getting Real About Health EquityCMS and state officials are using payment incentives, data collection and program requirements to start edging the lofty ideals of health equity toward reality.
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Using the Healthcare Utility Model to Manage Pharmacy Cost for Patients and PayersCivicaScript, a generic medication manufacturer, is modeling itself as public utility. It launched its first product, abiraterone 250 mg tablets, late last year and is gearing up to make its own low-cost insulin.
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Contract Management in a Value-Based Care EnvironmentFor operational efficiency, value-based initiatives need a scalable digital infrastructure that can handle multiple reimbursement models, including fee for service.
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Opportunities for HIV PrEP in Population HealthThe benefits of addressing barriers and increasing access to HIV PrEP therapies to high-risk populations across the globe.
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Enhancing Provider-Patient Relationships to Reverse Chronic DiseaseThe existing approach to chronic disease management is ill-suited to address the dynamic and diverse factors at play with chronic illness, argue the authors. Increase patient engagement and tailoring care to address root causes can create a large value-add, they say.
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Opinion: A Biden win, a Republican Senate and a slim Democratic majority in the House: That’s a recipe for compromise.With the 2020 election season nearly behind us, conventional wisdom is that we will have divided government: a Democratic president, a Republican Senate and a razor-thin Democratic majority in the U.S. House of Representatives. That combination is a recipe for compromise on President-elect Joe Biden’s healthcare priorities; namely, the federal response to the COVID-19 pandemic and adjustments to the ACA.
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Why Timing Matters When It Comes to PBM ContractingPlan sponsors should begin evaluation of PBM performance at least a year before the contract expires, say lawyers with expertise in PBM contracting.
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To Proactively Address SDOH, the ‘Top of Funnel’ is CriticalWe can identify and engage the right people. But to make a real difference in any community, a managed care organization, government agency or healthcare system needs to have a robust list/dataset of its population so the tools, processes and individuals that come after can do the work to identify and engage members with the highest needs.
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What’s Next in Healthcare Mergers & AcquisitionsLast year was a record setting year in worldwide merger and acquisition activity across multiple industries, and healthcare was a big part of that.
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Addressing Ransomware in HealthcareThere have been an alarming increase of ransomware attacks on healthcare systems in 2021—with more than 65 reported ransomware attacks on healthcare organizations in the third quarter alone and two-thirds of organization reporting that they had been targeted by ransomware strikes—a trend that is likely to continue in 2022.
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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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DOJ Issues Important Updates to Evaluation of Corporate Compliance GuidanceA strong, up-to-date compliance program should be part of a healthcare company's risk management strategy.
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Empowering the Next Generation of Nurse LeadersHealthcare organizations must encourage anyone in need to explore the mental health and wellness resources available at their institution.
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As the COVID-19 Pandemic Drives Record Telehealth Use, What’s Your Long-Term Plan?Preparing for a future that includes telehealth means considering revenue streams, ROI, facility planning and other factors.
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Addressing Ransomware in HealthcareThere have been an alarming increase of ransomware attacks on healthcare systems in 2021—with more than 65 reported ransomware attacks on healthcare organizations in the third quarter alone and two-thirds of organization reporting that they had been targeted by ransomware strikes—a trend that is likely to continue in 2022.
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Zeposia, Vumerity Tie on Efficacy but Zeposia Has Superior Safety ProfileFindings presented at the 2023 Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) were the first to compare the two drugs for relapsing-remitting multiple sclerosis.
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How AI Can Help Payers Streamline Prior Authorizations to Save Time, Improve Member CareMany prior authorizations requests still come in by fax. Natural language processing and artificial intelligence can extract and use information from faxes.
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The Urgent Case for Proactive Behavioral HealthcareThe healthcare system is facing an onslaught of patients with new and worsening conditions due the COVID-19 pandemic, but it is nowhere near ready to accommodate them.
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How Payers Can Weather the COVID-19 Storm – and Its AftermathCOVID-19 has revealed the power and value of data analytics as claims have gyrated in unprecedented ways.
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5 Tips for Health Plans to Improve Race and Ethnicity DataEquity is a central part of healthcare quality, but health plans often lack information on individual members’ race and ethnicity, making assessing and improving health outcomes challenging.
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Inside MAJIC-PV: A Closer Look at the Patient PopulationGabriela Hobbs, MD, describes characteristics of the patient population included in the MAJIC-PV study, and analyzes best available therapies received in the comparator arm.
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An Urgent Call to Reduce and Reuse Hospital Supplies for Stronger Financial, Environmental and Clinical SustainabilityNow is the time to take serious action to reform wasteful hospital practices and strengthen the healthcare supply chain. The high cost of American healthcare has topped headlines for years.
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Why 2021 Patient Experience Will be Tied to Telehealth SuccessHow consumers feel about their virtual care encounters will influence everything from CAHPS surveys to compensation beyond the pandemic.
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The Oncology Care Model Provides a Framework for the New Enhancing Oncology ModelThe new model starts in July 2023. Practices will be required to take on two-sided risk right from the start.
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The Keys to Effective Hybrid Care: Simplify, Streamline and AdaptIn the post-pandemic future, we will likely see that hybrid patient care models are the norm. As hospitals and health systems plan for this shift, they’ll need to consider two critical factors.
