Utilization: The Hidden Revenue Leak in VBC
High-performing groups treat utilization with the same rigor they apply to coding and quality. Here are four key principles we’ve seen successful organizations adopt.
PBGH CEO: Transparency is “Table Stakes” and an “Expectation”
In a recent interview, Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health, discussed employers' challenges in accessing medical data, emphasizing the need for transparency and potential strategies to enhance their fiduciary responsibilities.
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The Definitive Guide to Medical Billing Outsourcing: 5 Top Companies
In today’s healthcare landscape, your choice of medical billing partner directly impacts your bottom line. What are the best medical billing outsourcing companies, and which one is right for you?
The Critical Imperative for Health Plans to Tackle Late Payment Interest
Health plans can reduce late payment interest by up to 25% year over year by focusing on three critical areas.
The Kraft Heinz Lawsuit Against Aetna Is the ‘Tip of the Iceberg’
Kraft Heinz recently sued Aetna, claiming that the insurer is not providing all of Kraft Heinz's medical claims data. More lawsuits of this sort are likely to come, experts warned.
Trilliant Health releases index for more accurate hospital benchmarking, comparisons
Trilliant Health created a new AI-powered index for comparative hospital benchmarking. Healthcare stakeholders across the entire industry — including hospitals, payers, device companies, drugmakers and tech vendors — can use the tool to inform their strategies for things like competitive analysis, clinical quality program management, mergers, acquisitions and product sales.
State of denial and the power of AI
The fact that a majority of denied claims are preventable is only one aspect of a much deeper problem. Reworking claims take time, money, and resources. But here's how resource-strapped providers can leverage artificial intelligence to reimagine claims management.
The Human Algorithm: What AI Can’t Replace in Pharma Engagement
At a time when AI is reshaping pharma, Reverba Global CEO Cheryl Lubbert explained in an interview why empathy, context, and ethics still require a human touch.
Employers saw medical claims fall in 2020, but telehealth remains a larger part
According to an analysis of 1.8 million medical claims, employers’ claims were down 4% in 2020. Although telehealth visits plateaued at the end of the year, they made up nearly 1 in 5 visits.