How Healthcare Employers Can Do More To Help Providers Manage Payer Frustration
Health insurance claims are a growing headache for providers; many say their employers could do more to help them address the daily demands of insurers
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.
How Artera is Using Agentic AI to Humanize Patient Care
Artera President Tom McIntyre talks about the practical application of AI in healthcare.
It’s Time for Health Plans to Hold Behavioral Health Providers Accountable for Outcomes
For too long, the behavioral health industry has lacked the accountability mechanisms required to deliver on the high quality care that patients deserve. Provider organizations are proving day in, day out that when strong accountability becomes the standard, patients benefit, and the system as a whole grows stronger.
How Payers are Using AI to Deny Claims and Dent Provider Revenue
While AI has the potential to streamline processes, its current use in the revenue cycle is resulting in more claim denials, payment delays, and a greater need for appeals, particularly because payers often use AI to retroactively review medical necessity determinations.
Remote Patient Monitoring Works … What are Payers and Providers Waiting for?
To overcome challenges and ensure that RPM reaches its full potential, both providers and payers need to implement several key strategies — and technology is a key component to making everything easier on all organizations.
Unlocking Hidden Revenue: Transforming RCM Challenges into Financial Wins
As our industry continues its path toward value-based care, evolving payer models, and increasingly stringent regulations, revenue cycle processes will become even more complex. Providers can prepare by following these steps.
Beyond Analytics: How Sellers Dorsey is Hard-Coding Value into Medicaid Policy [Video]
How to turn analytics into actual policy outcomes.
Increasing Efficiency and Reimbursements with Clearinghouses
Clearinghouses are just one great example of how the enhanced exchange of healthcare data can increase efficiency for healthcare providers and the greater healthcare community.
Finding the Cure for Data Interoperability in Value-Based Care
Payers and providers alike are struggling with data interoperability. It's clear that a more unified approach to data management is essential for payers to effectively navigate the complexities of value-based care.
How Payers Use Tech to Support Healthcare Transformation
Executives at the ViVE Payer Insights event earlier this year discussed prior authorization, AI, value-based care and the role of tech to help achieve their goals.
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Unlocking Transparency in PBM Pricing
Dan Reedy, senior director of pricing and underwriting for Abarca, spoke recently with MedCity News about what payers should consider as they explore new models and press for greater transparency.
The Mechanics of a More Connected Healthcare Ecosystem [Video]
Arbiter’s Anjali Jameson on hospital and payer alignment.
Why Consumers Leave Their Payer/Provider
Many consumers leave their provider because of navigation problems, while many leave their insurer because of experience issues, a new Accenture report found.
Shifting the Payer Landscape with Health Tech
A new eBook from HLTH and MedCity News captures some of the ethical debates taking place in healthcare and looks ahead to how payers, providers and health tech companies are working together to address them. It also provides insights from executives in the field.
4 Funding Announcements Made By Payer/Employer Health Tech Startups in March
Here is a list of some of the biggest funding rounds in the payer/employer space that were announced this month.
EY: 65% of Healthcare Organizations Have Seen a Positive Return on Health Equity Efforts
A new report from Ernst & Young revealed that healthcare organizations are seeing financial benefits and improved outcomes from their health equity strategies.
We Need Your Self-Insured Employer Health Benefits Insights for Our Annual Survey
Do you advise self-insured employers? The 2023 Benefit Consultant Sentiment INDEX offered robust insights and cast a spotlight on the evolving roles of employers as they navigate the changing healthcare landscape. Your insights offer leading, innovative points of view that can guide employers and peers. Join us for this year's survey!