Connected Health Pulse

WebMD Ignite launches new member engagement platform for payers

FierceHealthIT

APRIL 24, 2024

WebMD Ignite is launching a new suite of tech tools it says will help payers turbocharge their clinical programs. WebMD Ignite is launching a new suite of tech tools it says will help payers turbocharge their clinical programs.

Pager Health's 3 new AI tools for payers could eliminate administrative costs

FierceHealthIT

APRIL 2, 2024

Virtual care navigation platform Pager Health has built three new enterprise tools using Google Cloud generative AI technology to better support its payer partners. Pager Health revealed three new tools for payers powered by Google on Wednesday.

UnitedHealth Group kicks off payer earnings, reports $5.5B in Q4 profit

FierceHealthIT

JANUARY 12, 2024

Industry giant UnitedHealth Group kicked off fourth-quarter earnings for major payers on Friday morning, where it reported $5.5 Industry giant UnitedHealth Group kicked off fourth-quarter earnings for major payers on Friday morning, where it reported $5.5 billion in profit. billion in profit.

HHS pressures UnitedHealth, payers on financial support for providers as cyberattack disruption continues

FierceHealthIT

MARCH 11, 2024

The federal government is pressing UnitedHealth Group and other payers to provide financial relief to providers as they continue to feel the financial disruption caused by the Change Healthcare cyb | The federal government is pressing UnitedHealth Group and other payers to provide financial relief to providers as they continue to feel the financial (..)

19 Massive Telehealth Learnings After 4,000,000 Visits in 2021

Speaker: Matt McBride, CEO and Co-Founder of Mend

As patient network communities and payers collect data, unifying it all poses serious challenges. However, due to the rapid rollout, many practices and health systems were forced to cut corners when establishing their Telehealth programs.

Telehealth

The Evolution of How Provider Organizations Share Data with Payers

Healthcare IT Today

MARCH 21, 2024

This includes an important focus area of MRO to be able to share data between providers and payers. Through such efficiencies, they reduce the burden on providers while letting payers build up longitudinal records on patients. Murray shares some of the solutions MRO has put in place to navigate around these challenges.

Interoperability

Interoperability FHIR Healthcare IT EMR

Medicare Advantage headwinds didn't prevent payers from turning a profit in 2023

FierceHealthIT

FEBRUARY 9, 2024

Though a spike in utilization among seniors slammed payers last year, particularly in the fourth quarter, each of the six major national firms turned a profit in 2023. Though a spike in utilization among seniors slammed payers last year, particularly in the fourth quarter, each of the six major national firms turned a profit in 2023.

Medicare

The Patient as Prescription Drug Payer – The GoodRx Playbook

Health Populi

OCTOBER 12, 2022

I collaborated with GoodRx on a “yellow paper” discussing The Health Consumers as Payer , with implications and calls-to-action for pharma and life science companies. The post The Patient as Prescription Drug Payer – The GoodRx Playbook appeared first on HealthPopuli.com. You can download the paper at this link.

Life Science

Life Science Medical Billing Pharmaceuticals

Maximizing ROI: 5 Telehealth Strategies That Benefit Payers and Providers

BHM Healthcare Solutions

APRIL 22, 2024

Cost-Effective Care: Virtual care delivery models provide a cost-effective alternative to traditional care, reducing expenses for payers and expanding revenue streams for providers. The post Maximizing ROI: 5 Telehealth Strategies That Benefit Payers and Providers appeared first on BHM Healthcare Solutions.

Telehealth

Telehealth Telemedicine

How the payer space changed in 2021, from virtual-first plans to digital mental health

Mobi Health News

DECEMBER 27, 2021

More payers launched virtual-first plans, insurtechs went public, and the digital mental health space brought in plenty of funding dollars this year.

Mental health

Leading Healthcare Payer Consulting Firm HealthScape Advisors Joins Chartis

Healthcare IT Today

FEBRUARY 21, 2024

This Acquisition Positions Chartis to Help Clients Achieve Transformational Healthcare Change Chartis , a leading healthcare advisory firm, today announced that it has acquired HealthScape Advisors , a leading healthcare payer consulting firm. I look forward to integrating our firm into Chartis.”

Medicare

Medicare Healthcare IT Health IT

Navigating the Interoperability Maze: 3 Key Challenges for Healthcare Providers and Payers

Healthcare IT Today

FEBRUARY 21, 2024

Additionally, the absence of universally accepted standards impedes the seamless flow of information between healthcare providers, payers, and other stakeholders. Both providers and payers may be accustomed to operating within siloed systems, and the prospect of adopting interoperable practices can be met with reluctance. InteropNow!

Interoperability

Interoperability Pharmaceuticals EHR Healthcare Cybersecurity

Clear Arch Health at Becker’s Payer Issues Roundtable, 2023

Clear Arch Health

OCTOBER 27, 2023

2023 Becker's Payer Issues Roundtable | Chicago, IL | Nov. 2023 Becker's Payer Issues Roundtable | Chicago, IL | Nov. In addition to having a strong focus on the larger issues facing payers, and health plans such as Medicare Advantage (quality improvement, member acquisition/retention/satisfaction, profitability etc.),

Medicare

Medicare Remote care Telehealth

The Power of Peer Review Networks For Payers

BHM Healthcare Solutions

APRIL 16, 2024

Discover the transformative impact of peer review networks for payers. The post The Power of Peer Review Networks For Payers appeared first on BHM Healthcare Solutions. Learn how these networks drive informed decisions and ROI.

The Patient as Consumer and Payer – A Focus on Financial Stress and Wellbeing

Health Populi

MAY 30, 2022

I appreciated the opportunity to share my perspectives on “The Patient As the Payer: How the Pandemic, Inflation, and Anxiety are Reshaping Consumers” in a webinar hosted by CarePayment on 25 May 2022. And that is part of the patient-as-payer’s workflow. In this post, I summarize some of the key issues we covered.

Medical Billing

Medical Billing Health Policy Mental health Patient Experience

Biden administration reinforces reproductive health obligations for payers, providers

FierceHealthIT

JANUARY 22, 2024

The Biden administration’s healthcare regulators released new guidances, informational resources and other actions that reinforce payers and hospitals’ federal obligations surrounding reproductive | New letters and instructional materials out of HHS come amid reported contraception coverage barriers and escalating legal challenges over emergency abortion (..)

Talkspace targets strong revenue growth in 2024 as it doubles down on payer, enterprise strategy

FierceHealthIT

FEBRUARY 23, 2024

Online therapy company Talkspace is doubling down on its strategy to grow its business with payers and employers with a focus on providing services to teens and seniors. Online therapy company Talkspace is doubling down on its strategy to grow its business with payers and employers with a focus on providing services to teens and seniors.

5 Strategies For Payer Efficiency Growth with Medical Necessity Criteria

BHM Healthcare Solutions

APRIL 18, 2024

Learn strategies for maximizing payer efficiency with medical necessity criteria. The post 5 Strategies For Payer Efficiency Growth with Medical Necessity Criteria appeared first on BHM Healthcare Solutions. Manage costs, ensure quality care, and comply with regulations effectively.

Payer Roundup—Blue Cross Blue Shield Association lawsuit unfolds; Rightway raises $109M; Surescripts reportedly eyes sale

FierceHealthIT

APRIL 5, 2024

Payer Roundup—Blue Cross Blue Shield Association lawsuit unfolds; Rightway raises $109M; Surescripts reportedly eyes sale ntong Fri, 04/05/2024 - 16:02

CVS, Oscar Health and Geisinger join 25 other payers, providers to sign AI safety pledge

FierceHealthIT

DECEMBER 15, 2023

More than two dozen healthcare payers and providers, including CVS, Premera Blue Cross and Mass General Brigham, are making voluntary safety, security and transparency commitments to the White Hous | More than two dozen healthcare payers and providers are making voluntary safety, security and transparency commitments to the White House regarding the (..)

Payers' increasing claims denials, delays 'wreaking havoc' on provider revenue cycles

FierceHealthIT

DECEMBER 13, 2023

A jump in claim delays and denials is “wreaking havoc on providers’ revenue cycle performance” and contributing to health systems’ “volatile” accounts receivable and diminishing cash reserves, acco | More frequent pushback from commercial and Medicare Advantage payers is complicating patient self-pay collections and, ultimately, undermining the revenues (..)

Medicare

MRO – Bridging the Trust Gap Between Providers and Payers, One Record at a Time

Healthcare IT Today

NOVEMBER 29, 2023

MRO wants to make the exchange of data between providers and payers more frictionless. They have developed a new solution that caters to this payer-provider interface. By bridging this data gap, MRO aims to enhance trust between providers and payers. We must own the fact that there is a trust divide between payers and providers.

Interoperability

Interoperability Healthcare IT Health Information EHR

Could contentious payer-provider negotiations become the post-COVID norm?

FierceHealthIT

SEPTEMBER 13, 2023

Providers are under significant pressure as the COVID-19 pandemic effects wear on, so it shouldn't come as a surprise that they're pushing payers for more in contract negotiations. However, certain deals of late have gotten highly contentious—and gone public in a way that isn't typical for the industry.

Digital health company Waltz Health charts move into payer market

FierceHealthIT

SEPTEMBER 26, 2023

Digital health company Waltz Health is cracking into the payer market by inking its first partnership. Digital health company Waltz Health is cracking into the payer market by inking its first partnership.

Digital Health

Innovating Payer Offerings: Revolutionizing Health Insurance

BHM Healthcare Solutions

JANUARY 16, 2024

The imperative to innovate payer offerings has become more pronounced than ever. The post Innovating Payer Offerings: Revolutionizing Health Insurance appeared first on BHM Healthcare Solutions.

Payer Roundup–Humana confirms layoffs; Medicaid expansion linked to lung cancer survival

FierceHealthIT

JANUARY 18, 2024

Below is a round-up of payer-centric news for the week of Jan. 2024 | This week, Humana announced workforce reductions, a study associated Medicaid expansion with reduced lung cancer mortality and Bright Health moved its corporate headquarters.

Payer Roundup—Elevance Health acquires New York-based MCO; Sentara Health Plans under investigation

FierceHealthIT

APRIL 17, 2024

Below is a roundup of payer-centric news for the week of April 15, 2024. This week, Elevance Health acquires its competitor in New York, a Virginia health plan is under investigation and the OIG office looks into vertical consolidation.

Virtual SUD clinic Pelago clinches $58M to expand offerings for payers, employers

FierceHealthIT

MARCH 28, 2024

Pelago, a virtual substance use disorder (SUD) clinic working with payers and employers, has clinched $58 million in a series C round. Pelago offers integrated SUD management for employers and payers, with specialized treatment for tobacco, alcohol and opioid use disorders.

Employer Health Plan Strategies: 5 Strategic Insights for Payers

BHM Healthcare Solutions

MARCH 19, 2024

The post Employer Health Plan Strategies: 5 Strategic Insights for Payers appeared first on BHM Healthcare Solutions. Learn key challenges in managing employer health plans, including cost management and compliance. Discover strategies to overcome hurdles.

What is Payer Initiated Reduction (PIR)?

BHM Healthcare Solutions

FEBRUARY 29, 2024

Explore what Payer Initiated Reduction (PIR) is and its impact on healthcare insurance and provider reimbursements. The post What is Payer Initiated Reduction (PIR)? appeared first on BHM Healthcare Solutions.

Payer Roundup–L.A. Care Health Plan addressing PPE shortages; new Cost Plus Drugs partnership

FierceHealthIT

JANUARY 25, 2024

Below is a round-up of payer-centric news for the week of Jan. 22, 2024 | This week, California health plans formed a coalition to address long-term PPE shortages, Mark Cuban's drug company announced a new partnership with Livinity, popularity rises for Colorado's public option plans and more.

2024 Outlook: How experts say payers will—or should—try to improve their Medicare Advantage star ratings

FierceHealthIT

DECEMBER 18, 2023

Payers need to properly adapt to changes made to the Medicare Advantage star ratings program or risk financial repercussions, industry experts told Fierce Healthcare. Payers are being urged to prioritize health equity considerations more than ever before to improve their Medicare Advantage star ratings scores.

Medicare

Why Trinity, Anthem execs say payer-provider negotiations don't need to get heated

FierceHealthIT

JANUARY 12, 2024

While market pressures have often left payers and providers at odds in contract negotiations, leaders at Trinity Health and Anthem Blue Cross said that things don't always have to be this way. | The two announced Thursday that they had reached an agreement to extend their network agreement for multiple years.

Inovalon Adds All-Payer Claims Management Software To The PointClickCare Marketplace

Electronic Health Reporter

FEBRUARY 2, 2023

Inovalon, a leading provider of cloud-based software solutions empowering data-driven healthcare, today announced the addition of its EASE All-Payer claims management solution to the PointClickCare Marketplace.

MRO Satisfies Payer Medical Record Requests Automatically

Healthcare IT Today

JULY 26, 2023

Because data allows for better decision-making, patient records are being requested by payers, communities of care, and patients themselves. However, this can sometimes be overwhelming for healthcare provider organizations that are now getting larger and larger volumes of requests from payers which inundate their systems.

Interoperability

Interoperability FHIR Healthcare IT Health IT

Utilization Management: A Cornerstone in Payer Efficiency

BHM Healthcare Solutions

JANUARY 23, 2024

Utilization management (UM) is a comprehensive strategy that payer organizations deploy to assess and control the appropriateness of healthcare services. The post Utilization Management: A Cornerstone in Payer Efficiency appeared first on BHM Healthcare Solutions.

Prior Authorization: How Does It Affect Payers?

BHM Healthcare Solutions

FEBRUARY 7, 2024

However, the current complexities create challenges for payers, impacting both financial implications and administrative burdens. In this blog post, we will delve into the nuances of prior authorization, exploring its effects on payers and unveiling best practices for a more sustainable and efficient healthcare system.

Industry Voices—How 2nd opinions can save payers and satisfy patients

FierceHealthIT

APRIL 19, 2024

Payers face a multifaceted challenge of managing rising healthcare costs while also meeting the heightened expectations of consumers who expect medical interactions to be as personalized and conven | Third-party analyses recently commissioned by The Clinic by Cleveland Clinic showed medical cost savings from, and high consumer interest in, virtual (..)

Healthcare Payers Address Immediate and Long-Term Impacts of COVID-19

Electronic Health Reporter

AUGUST 9, 2020

The COVID-19 crisis has created a perfect storm of challenges for payers as they adapt to a new normal that continues to evolve. The article Healthcare Payers Address Immediate and Long-Term Impacts of COVID-19 appeared first on electronichealthreporter.com. By William Flood, MD, MS, chief medical officer/Eviti, NantHealth.

Using the digital therapeutics engagement chain to attract payer partnerships

Mobi Health News

FEBRUARY 25, 2021

Panelists from DTx West share how they successfully executed a digital therapeutic and payer relationship. .

Health Technology

Health Technology Digital Health

Lawmakers, payers and providers all air grievances with federal No Surprises Act implementation

FierceHealthIT

SEPTEMBER 20, 2023

Providers and payers, meanwhile, didn't see eye to eye on which industry camp is treated unfairly under the current regulations outlining billing dispute arbitration.

VBA Provides A Suite of Tools for Payers and TPAs Including a New Generative AI Product

Healthcare IT Today

MARCH 26, 2024

VBA offers numerous portals to payers and their clients (which include doctors, patients, brokers, and more)—”one-stop shopping” for a large range of services. To ease the user experience with these services, the company has started using generative AI for training on their platform through a tool called VBA Assist.

Healthcare IT

Healthcare IT Leadership Health IT

5 Healthcare Performance Improvement Initiatives Optimize Payer Ops

BHM Healthcare Solutions

DECEMBER 8, 2023

Healthcare performance improvement initiatives emerge as key catalysts, intricately shaping the efficiency and effectiveness of payer operations. This article explores the substantial impact these initiatives wield in optimizing payer processes, ultimately elevating the quality of patient care.

Payer Roundup–Molina Healthcare strengthens partnership with BeMe Health; North Carolina health plan limits GLP-1 coverage

FierceHealthIT

JANUARY 30, 2024

Payer Roundup–Molina Healthcare strengthens partnership with BeMe Health; North Carolina health plan limits GLP-1 coverage ntong Tue, 01/30/2024 - 16:37

WebMD Ignite launches new member engagement platform for payers

Pager Health's 3 new AI tools for payers could eliminate administrative costs

Trending Sources

UnitedHealth Group kicks off payer earnings, reports $5.5B in Q4 profit

HHS pressures UnitedHealth, payers on financial support for providers as cyberattack disruption continues

19 Massive Telehealth Learnings After 4,000,000 Visits in 2021

The Evolution of How Provider Organizations Share Data with Payers

Medicare Advantage headwinds didn't prevent payers from turning a profit in 2023

The Patient as Prescription Drug Payer – The GoodRx Playbook

Maximizing ROI: 5 Telehealth Strategies That Benefit Payers and Providers

How the payer space changed in 2021, from virtual-first plans to digital mental health

Leading Healthcare Payer Consulting Firm HealthScape Advisors Joins Chartis

Navigating the Interoperability Maze: 3 Key Challenges for Healthcare Providers and Payers

Clear Arch Health at Becker’s Payer Issues Roundtable, 2023

The Power of Peer Review Networks For Payers

The Patient as Consumer and Payer – A Focus on Financial Stress and Wellbeing

Biden administration reinforces reproductive health obligations for payers, providers

Talkspace targets strong revenue growth in 2024 as it doubles down on payer, enterprise strategy

5 Strategies For Payer Efficiency Growth with Medical Necessity Criteria

Payer Roundup—Blue Cross Blue Shield Association lawsuit unfolds; Rightway raises $109M; Surescripts reportedly eyes sale

CVS, Oscar Health and Geisinger join 25 other payers, providers to sign AI safety pledge

Payers' increasing claims denials, delays 'wreaking havoc' on provider revenue cycles

MRO – Bridging the Trust Gap Between Providers and Payers, One Record at a Time

Could contentious payer-provider negotiations become the post-COVID norm?

Digital health company Waltz Health charts move into payer market

Innovating Payer Offerings: Revolutionizing Health Insurance

Payer Roundup–Humana confirms layoffs; Medicaid expansion linked to lung cancer survival

Payer Roundup—Elevance Health acquires New York-based MCO; Sentara Health Plans under investigation

Virtual SUD clinic Pelago clinches $58M to expand offerings for payers, employers

Employer Health Plan Strategies: 5 Strategic Insights for Payers

What is Payer Initiated Reduction (PIR)?

Payer Roundup–L.A. Care Health Plan addressing PPE shortages; new Cost Plus Drugs partnership

2024 Outlook: How experts say payers will—or should—try to improve their Medicare Advantage star ratings

Why Trinity, Anthem execs say payer-provider negotiations don't need to get heated

Inovalon Adds All-Payer Claims Management Software To The PointClickCare Marketplace

MRO Satisfies Payer Medical Record Requests Automatically

Utilization Management: A Cornerstone in Payer Efficiency

Prior Authorization: How Does It Affect Payers?

Industry Voices—How 2nd opinions can save payers and satisfy patients

Healthcare Payers Address Immediate and Long-Term Impacts of COVID-19

Using the digital therapeutics engagement chain to attract payer partnerships

Lawmakers, payers and providers all air grievances with federal No Surprises Act implementation

VBA Provides A Suite of Tools for Payers and TPAs Including a New Generative AI Product

5 Healthcare Performance Improvement Initiatives Optimize Payer Ops

Payer Roundup–Molina Healthcare strengthens partnership with BeMe Health; North Carolina health plan limits GLP-1 coverage

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