Better AI + Correct Provider Guidance = Fewer Denials
How do we tip the scale to lower the rate of denials? While AI has been the initial decision-maker for years, it must become better trained. And to do that, it needs help.
Healthcare’s Next Frontier: Building a Fully Connected Experience
It comes down to two simple questions that every health plan should consider: “Are we a company that pays for services and manages risks? Or are we a company that delivers better health for our members?”
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Why Your Patients Are Leaving and How to Stop It
Patient expectations continue to evolve, and healthcare practices that fail to adapt risk more than just revenue—they risk losing trust.
Analyzing the Medicare Advantage Terminations: Concerns, Drivers, and Solutions
Both providers and payers face challenges and understanding the requirements and needs of each stakeholder has the potential to lower the temperature of the current rhetoric.
Payers Are Putting Profit Over Patients with Denials and Prior Auth Policies, Hospitals Say
Hospitals are facing increasingly burdensome policies from commercial insurers, leading to problems with cash flow and patient safety. Hospital executives think federal regulators need to enact stricter policies that require payers to operate on faster timelines, as well as provide more transparency into their reasons for denying claims.
The Carbon/Anthem Blue Cross Spat Is Nothing New, Just More Public
Carbon went out of Anthem Blue Cross’ network March 17 after not coming to an agreement on reimbursement. The company took the dispute public in an April 29 blog post declaring the rate Anthem pays its providers as not a livable wage. These kinds of disputes between payers and providers happen frequently, though they're usually not as public, one expert said.
Panel Orders UnitedHealthcare to pay $10.8M for Allegedly Underpaying Physicians
The lawsuit is one of nine cases throughout the country that TeamHealth has brought against United for alleged underpayments. The other eight cases are still ongoing.
A Data-Driven Guide to Patient Access Success
A new report from Relatient, A Data-Driven Guide to Patient Access Succes, highlights how focusing on data accuracy and relevance can enhance the performance of healthcare practices.
Report: Provider, payer websites are go-to online resources for patients making care decisions
Healthcare consumers are increasingly turning to the internet to research their care options, and provider and payer websites are among their top choices for information, according to a new survey of 1,000 U.S. adults. Over half of the respondents said they would use a provider or payer website to search for a new doctor.
AMA report: U.S. has “highly concentrated” payer markets that stifle competition
About 73% of health insurance markets are highly concentrated, and in 46% of markets, one insurer had a share of 50% or more, a new report from the American Medical Association shows. The report comes a few months after President Joe Biden directed federal agencies to ramp up oversight of healthcare consolidation.
CareFirst unveils virtual-first primary care practice
The practice, which initially will only be offered to CareFirst BCBS commercial members, provides an array of services, including preventive care, insurance navigation and behavioral and mental health services. Patients will be referred to in-person care with local providers when needed.
Insurer price transparency rule faces legal challenges: 4 takeaways
Two lawsuits, filed by the U.S. Chamber of Commerce and the Pharmaceutical Care Management Association, allege that portions of the price transparency rule governing insurers are unlawful and would drive up healthcare prices, contrary to the rule's stated aim.
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How to Improve Employee Benefits While Reducing Insurance Costs
Balancing healthcare benefits and insurance costs requires research. From becoming a Difference Card member to offering wellness resources, there are many ways to improve healthcare at low cost.
Report: Medicare Advantage startup AllyAlign Health nabs $300M
AllyAlign Health, which offers health plans for seniors like Medicare Advantage and institutional special needs plans, has raised $300 million in funding. It will use the funds to scale its business.
UnitedHealthcare’s new social determinants effort spans 23 programs
The payer's Community Catalyst initiative includes 23 programs that involve collaborations with various community-based organizations and health centers. They tackle different types of social determinants of health issues, including food insecurity among seniors and the health needs of those in public housing.
Anthem, Epic strike data exchange partnership
The EHR giant will integrate its payer platform with the insurer's operating system to facilitate two-way data exchange with providers. Through this integration, the organizations hope to support clinical decision-making and streamline administrative processes like prior authorizations.
Tech-enabled payer Brella Insurance snags $15M
The health insurance technology company has raised $15 million in a Series A funding round. It will use the funds to expand access to its supplemental health plan nationwide and engage in new partnerships.
Lawsuit: Like a “boa constrictor,” UnitedHealthcare squeezed anesthesia group out of competition
U.S. Anesthesia Partners has filed lawsuits against UnitedHealthcare in Colorado and Texas, accusing the payer of forcing it out of network and intentionally interfering with its relationships with providers in those states. But, according to UnitedHealthcare, the lawsuits are an attempt to get the insurer to meet the anesthesia group's high rate demands.