Expedite Patient Care and Reduce the Burden Between Payers and Providers with Edifecs Automated Prior Authorization Solution Prior authorization has long been a burden across the healthcare industry, impacting payers, providers, and patients alike. Although a well-intended tool for utilization management (UM), prior authorization has often come under fire for creating extra red tape, resulting...
This post is the first in a five-part series highlighting top insights from our white paper, Personalized Value-Based Care: Effective Multi-Generational Care Management Strategies. Addressing generation-specific attitudes, concerns, and preferences regarding healthcare, as well as non-clinical factors that impact health like social determinants of health (SDOH), is integral to member engagement and better outcomes. In this...
The impact of health knowledge and what care managers can do to improve health literacy in 2023 In October 2022, VirtualHealth discussed the rising importance of health literacy with Christy Calhoun, MPH, Chief Content Officer, Healthwise, and our own Lori Coates, N-BC, CCM, CCTM, Director of Population Health and Value-Based Care Solutions. Here, we further...
The term “payvider” isn’t new. It’s part of the inspiration behind our HELIOS platform – to enable and support value-based partnerships between payers and providers. But in recent years, the desire of health systems to become involved in risk management has increased. A survey in 2021 found that nearly 60% of health systems aimed to...
A discussion with leading experts in health education and care management Due to the rising importance of health literacy to improving individuals’ health outcomes and well-being, as well as eliminating health disparities and achieving health equity, VirtualHealth sat down with Healthwise Chief Content Officer Christy Calhoun, MPH, and our own Director of Population Health and...
Member engagement is about more than higher Medicare Star Ratings and keeping member bases loyal. A highly engaged health plan member is one who is actively involved in their health and wellness, and one who is more likely to adhere to care plan instructions, treatment, and medication regimens, and prioritize improving their overall state of health and well-being. Today, Medicare beneficiaries...
Q&A with CEO and Founder Adam Sabloff and Vice President of Product Management Marcus Caraballo. The healthcare industry is evolving. As more and more organizations seek to implement a value-based care approach, many are realizing the importance of data interoperability, whole-person health, and the need to address and solve for social determinants of health (SDOH)....
This is the first article in a six-part series exploring ways to improve the delivery of whole-person, value-based care to Medicare and Medicare Advantage populations. Here, we dive into our first area of focus: ensuring optimal care for members who need long-term services and supports (LTSS), for which Medicare does not provide comprehensive coverage. You...
Every year the Centers for Medicare & Medicaid Services (CMS) releases the Star Ratings for Medicare Advantage plans. The Medicare Star Rating System was developed to help Medicare consumers compare Medicare Advantage plans based on quality and performance. Star ratings are determined from a set of quality performance ratings developed by the National Committee for...
Behavioral health and mental health conditions are highly prevalent across generations. About 11% of adults and 3% of youth had alcohol use disorder and 21% of U.S. adults had a mental health condition such as depression, anxiety, or schizophrenia a 2020 National Survey on Drug Use and Health found. More recently the U.S. Department of...
