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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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Inflation Reduction Act: Reforms to Patient Cost-SharingLower out-of-pocket costs for patients might put upward pressure on drug prices, as manufacturers face less price sensitivity, note Matthew Majewski and Rhett Johnson of Charles River Associates. But they also note that upward pressure on price is likely to be limited to the inflation rate as any additional price increase would need to be paid back to CMS in the form of inflation rebates.
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3 Approaches to Creating a Connected Care FutureBy integrating capabilities and services, we can create health experiences that are much more than the sum of their parts
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Building a Culture of ResiliencyEmphasizing best practices and a healthy culture rather than focusing narrowly on compensation will help medical groups thrive.
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The Reaching Impact of Health Disparities: Why Closing the Gap Begins Before BirthManaged care organizations must ensure that all of their members—including their youngest—receive the most equitable start in life. Here’s how to get started.
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The Convergence of High Tech and HealthcareThe growth of digital twin technology — paired with the transition towards personalized medicine — has left many healthcare industry professionals evaluating the potential of a “patient twin.”
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How the Pandemic Has Shifted the Benefits ConversationThe benefits space is changing and there is currently a shift to “enviable benefits” - ones that go beyond traditional health and retirement coverage. Many companies, especially those still doing well during the economic downturn, have ramped up benefits communication about existing support programs such as telemedicine, financial well-being and childcare.
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What’s Needed to Navigate America’s Mental Health Care CrisisDemand for mental health care is booming. With a shortage of psychiatrists, author of this opinion piece, Robert Krayn, asks how can we ensure providers are empowered to deliver the best care possible for their patients?
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3 Ways to Embrace the Digital Age in HealthcareThere are many misconceptions about healthcare technology, but you can improve your organization’s approach to IT by clearing them up and following these three steps.
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Advanced Analytics: an Essential Tool for Value-Based Care SuccessData analytics allows providers to gain insights from performance management measures and metrics that hold the clues to financial viability under risk-based and pay-for-performance contracts. By embracing advanced analytics, hospitals and health systems can accelerate their path to value.
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Artificial Intelligence Saves Payers Time and MoneyArtificial intelligence can help deal with everyday problems such as prior authorization and high utilization. But payers are also eyeing it for loftier purposes.
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Why Telehealth and Continuous Remote Patient Monitoring Has Staying Power Beyond COVID-19Telehealth solutions are here to stay.
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While We Await Vaccine Progress, We Can Trust in Generic DrugsGeneric drugs account for 90% of the prescriptions filled in the United States. They are the backbone of healthcare providers’ treatment protocol and they are remarkably cost effective: despite being 90% of the prescriptions filled, generics account for only 20% of drug spending.
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Future of Wet AMD TreatmentDiana Do, MD, and Steven Peskin, MD, MBA, FACP, discuss unmet needs and future approaches to treatment in wet AMD.
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Considering the Ideal Role for Non-Emergency Medical Transportation in Addressing SDoH in Medicaid and Medicare PopulationsMedicare and Medicaid programs that serve the most-vulnerable Americans facing SDOH barriers can be major facilitators of appropriate non-emergency transportation to non-medical sites. But how do we determine what is appropriate, and what do we know about transportation services to non-medical sites today?
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5 Tips for Employers on Reforming and Optimizing Medication UseLives can be saved, physician burnout and waste can be reduced, and drug costs can decrease by achieving medication optimization through comprehensive medication management.
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Overcoming Cancer’s Financial Toxicity with Real-World DataFinancial Toxicity is a growing concern for many cancer patients and caregivers, and with the continued rise in treatment costs, it can no longer be ignored.
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How AI is Changing the Conversation Around Hospital Denials – and Improving Financial Implications in the ProcessIn an early 2023 brief published by KFF, CMS transparency data for 2021 revealed an average denial rate of 17% for all in-network claims, with authorization denials reported as high as 24% of denial volume for some plans and medical necessity denial rates as high as 37% for others.
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Future of Wet AMD TreatmentDiana Do, MD, and Steven Peskin, MD, MBA, FACP, discuss unmet needs and future approaches to treatment in wet AMD.
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Data Interoperability is Essential to Vaccination SuccessCOVID-19 is not in the rearview mirror. Greater collaboration among organizations, and a new sense of purpose with regard to interoperability, is essential in this new era.
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4 Ways Insurers Can Turn ‘Embarrassment of Profits’ into Solutions that MatterEven as many industries continue to suffer devastating setbacks due to the COVID-19 pandemic, one sector that has enjoyed an “embarrassment of profits” is health insurance.
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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 How and Why of Enterprisewide Clinical Data Integration StrategyClinical data integration can mean navigating through an obstacle course of organizational and technical challenges. But it can show its ROI bona fides with digital chart review and other efforts.
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Older Women More Prone to C Diff, COVID-19 CoinfectionThose with certain comorbidities, including peptic ulcer disease and renal failure, were at additional risk of developing C diff infection.
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Four Ways Medicare Advantage Plans Can Stay Ahead of OIG Denial ConcernsA recent HHS Office of Inspector General's report found that Medicare Advantage (MA) plans inappropriately deny prior authorization requests. With MA enrollment growing, scrutiny of MA plans and their utilization management strategies is also likely to grow, according to Alina Czekai, M.P.H., of Cohere Health. Czekai argues that artificial intelligence and machine learning can improve utilization management and prevent inappropriate denials.
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Improving Member Perception: How Health Plans Can More Effectively Move the NeedleElevating customer services isn’t enough to raise Star ratings and quality. Payers and their provider partners also need to meet patients at their level.
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Use Quick Wins to Speed Your Healthcare Digital TransformationWhat does it take for a healthcare organization to effectively expedite and achieve a digital transformation? Start with the fundamentals, like having an integrated transformation strategy with clear goals across the enterprise, highly visible and vocal top-down leadership, and exceptional tactical talent for implementation.
