Healthcare Payers and Providers: Combining Resources with Technology Players to Control Costs

The Affordable Care Act (ACA) has brought about a lot of changes in the healthcare industry in the United States. One such instance is the requirement of plans sold through the Health Insurance Marketplace to cover treatment for pre-existing medical conditions. Because of this, payers can’t deny coverage to high-risk patients or charge them exorbitant […]

Predictive Analytics in Healthcare: Transitioning Data into Actionable Insight

We can’t predict the future, however, the healthcare industry is working to address cost and utilization issues through predictive analytics. As defined by CIO Magazine, predictive analytics is a category of data analytics aimed at making predictions about future outcomes based on historical data and analytics techniques that can generate future insights with a significant […]

Third-Party Reviewers: Offering Streamlined Solutions for Payment Integrity

Unfortunately, the healthcare industry faces challenges with financial waste. It has been estimated that the healthcare system in the United States wastes approximately $765 billion annually, about 25 percent of what is spent. Part of this number is due to payment integrity issues such as fraud, waste and abuse (FWA). If you’re not familiar with […]

Summer 2019: Healthcare Updates to Know

Each season brings new changes and modifications to the healthcare industry. With summer here, we’ve highlighted important issues, healthcare coverage changes and advances in medical research. Cybersecurity Still Troubles the Industry The healthcare industry continues to be plagued by cybersecurity issues. A newly published 2019 Data Breach Investigations Report from Verizon found that of the […]

How Healthcare Organizations Can Tackle Social Determinants of Health

There’s no way around it–healthcare in the United States is expensive. This country spends about twice as much per person compared to other developed nations. One key way healthcare organizations are addressing these issues is factoring in social determinants of health (SDOH). The World Health Organization defines SDOH as “the conditions in which people are […]

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