Prior authorization can cause serious issues for members and providers if processes are not properly architected by a healthcare payor. More than nine in 10 physicians (94%) reported care delays while waiting for health care insurers to authorize necessary care, a physician survey by the American Medical Association found. Eighty percent said prior authorization can lead to treatment abandonment, and 33% reported prior authorization issues have led to serious adverse events including hospitalization, disability, or even death. These pain points are felt by healthcare payors too. Inefficient or inaccurate prior authorization can lead to costly mistakes, tense provider relationships that...
Q&A: The State of Care Management and Value-Based Care
A recent survey from Becker’s Healthcare and VirtualHealth revealed what healthcare payers really think about the current state of value-based care and care management. The results show key obstacles still exist.
Clearinghouse Services for Michigan and Minnesota
For more than 14 years, HealthEC has been providing fast, easy-to-use, and dependable electronic claims submission services for health organizations both large and small.
How Can Healthcare Plans Empower Members to be Active Participants in Their Health?
When people have the knowledge, skills, and confidence to engage in their own health, better outcomes are much more achievable. According to the Centers for Disease Control and Prevention (CDC), this conclusion was based on a research review that linked better health outcomes to higher levels of activation (having the knowledge, skills, and confidence to be engaged in their health) and health literacy. Active participation and engagement are also tied to higher satisfaction. Payers can use these insights to further health outcome goals by taking steps to improve member participation in a few key areas: Position care managers to better...
5 Strategies to Re-Engage Members in a Post-Covid World
The worst of COVID-19 may be retreating into the rearview, but the pandemic’s effect on general population health lingers. Whether it was limited access to care, fear of exposure, or tangential factors like lack of childcare, people of all ages and socioeconomic backgrounds put preventive care on pause. That has led to: Delays in care Missed cancer screenings and colonoscopies (the American Cancer Society reported significant drops in cervical, breast, and colorectal cancer screenings in 2020) Missed well visits Missed behavioral health therapy As recently as 2022, a survey by the Prevent Cancer Foundation found that 50 percent of Americans...
How Can You Meet Healthcare Expectations of Millennials?
This post is the final post in a five-part series highlighting top insights from our white paper, Personalized Value-Based Care: Effective Multi-Generational Care Management Strategies. It’s true that meeting the health needs of individuals across generations is partly about age-related clinical factors. But there’s much more to consider. Addressing generation-specific attitudes, concerns, and preferences regarding healthcare, as well as individual non-clinical factors that impact health, is integral to member engagement and better outcomes. Here, we explore how organizations can improve delivery of personalized, value-based care at scale for Millennial health populations. What Makes Millennials Unique When It Comes to Healthcare?...
6 Reasons Why Predictive Analytics are the Future of Healthcare
Healthcare powered by predictive analytics is transforming the healthcare space. From enabling more accurate and proactive care delivery and better patient outcomes to streamlining provider processes and workflows. And with continued advances in machine learning, and healthcare technologies constantly honing the accuracy of predictive models and algorithms, it’s clear that the future of healthcare will be driven by predictive models. Predictive analytics can shift care approaches to become more proactive, including: Better inform and guide care decisions with real-time patient data and 360-views Streamline care delivery models with preconfigured risk notifications and tasks Identify patient behavior patterns and care gaps...
How Can You Engage Generation Z in Healthcare?
This is the final post in a five-part series highlighting top insights from our white paper, Personalized Value-Based Care: Effective Multi-Generational Care Management Strategies. It’s true that meeting the health needs of individuals across generations is partly about age-related clinical factors. But there’s much more to consider. Addressing generation-specific attitudes, concerns, and preferences regarding healthcare, as well as individual non-clinical factors that impact health, is integral to member engagement and better outcomes. Here, we explore how organizations can improve the delivery of personalized, value-based care at scale for Generation Z health populations. What Makes Generation Z Unique When It Comes...
3 Reasons Why It’s Time for You to Update Your Utilization Management Solution
In the last few years, challenges related to prior authorization have created inefficiencies in health care that negatively impact both health outcomes for members and the costs both payers and members must pay. That’s why in December 2022, the Centers for Medicare & Medicaid Services (CMS) proposed Rule CMS-0057-P. The new rule is designed to advance interoperability goals and improve prior authorization processes to enable more accurate, more effective care for Medicare and Medicaid beneficiaries. And it is one of the top reasons why we see companies researching an update to their utilization management (UM) systems. See below for the...
How Can We Improve Health Literacy among Medicaid Populations?
Inadequate health literacy affects nearly 36% of the adult U.S. population and is found in disproportionately higher rates among Medicaid-eligible populations, according to the Center for Health Care Strategies. In fact, one study estimates that more than 25% of uninsured, Medicare, and Medicaid populations may have low health literacy skills. This can negatively impact quality of life and health outcomes for members as well as drive up the cost of care. Why Prioritize Health Literacy? The U.S. government’s Healthy People 2030 initiative defines health literacy as “the degree to which individuals have the ability to find, understand, and use information and services to inform...