With home health fraud growing more sophisticated through AI, post-pay audits are no longer enough. Payers must shift to proactive, tech-driven prevention to catch improper claims before paying them.
The between a code that satisfies a payer and the information a physician needs to treat a person, is what nearly every healthcare AI tool is racing past. As we push these systems toward precision medicine and genomics, that gap stops being an annoyance and becomes a patient safety issue.
In an interview, Kyan Health Co-Founder and Chief Commercial Officer Konstantin Struck discussed how Kyan gives mid-market and enterprise employers access to premium workforce mental healthcare, at a price point that is affordable.
A new whitepaper by League highlights examples from collaborations with Baptist Health.
VBC aligns reimbursements to outcomes, emphasizing the quality and effectiveness, not quantity, of healthcare activities. But the same cost constraints driving interest in VBC can also turn it into a liability.
A five minute survey from MedCity News asks payers what they think of AI and how it is being implemented. Participate today and we will reward you!
On July 22, a webinar sponsored by Verato will spotlight perspectives of executives from Scan Health Plan and the Alliance of Community Health Plans.
We are taking a look at how health insurers are using AI, defining success, and managing cybersecurity risks. Give us your opinions by completing our brief, anonymous survey.
The honest question is not whether AI will end the fight. It will not. The honest question is what AI does to a fight that has been structurally imbalanced for 30 years.
For many of Medicaid’s highest-need members, the problem isn’t that services don’t exist. It’s that the system can’t consistently reach the people who need those services most.
To truly deliver on the promise of proactive, preventive care for seniors with complex, chronic conditions, we should move away from the current one-year open enrollment cycle and toward a five-year contract period.
For someone already managing chronic disease, menopause can disrupt stability and complicate treatment plans in ways that aren’t always immediately visible but show up over time in outcomes and utilization.
By reducing administrative burden and redesigning workflows around human needs, it creates space for what matters most: connection between clinicians and patients.
A webinar by Verato and MedCity News on July 22 will explore how building a trusted data foundation that connects the healthcare ecosystem can improve how payers deploy AI.
Focusing on fringe cases of abuse misses a more immediate and arguably more pervasive problem: many provider organizations are not getting the access to IDR they’re entitled to because the process is too difficult to navigate effectively at scale.
Healthcare does not lack the data needed to better understand oncology costs. What it does lack is a consistent way to connect clinical progression with financial impact in a time frame that aligns with strategic planning.
It starts with a simple mindset shift, realizing that a successful AI journey begins with identifying a business problem, not with technology. The plans that make real progress embrace this mindset first then follow these five steps.
States must rethink how program integrity is designed and delivered by focusing on four key priorities that enable oversight to scale alongside these programs.