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...
Three Benefits to Having Care Management and Utilization Management Software on a Single Platform
In theory, utilization management (UM) should reduce the overall cost of care while improving outcomes for health plan members. But for many payers and providers using homegrown solutions and outdated, siloed platforms, the reality is much different. Without the ability to sync and share data across teams and departments, it’s nearly impossible to gain a comprehensive understanding of member health and care services. Moreover, manual processes and burdensome paperwork take valuable time away from what matters most: delivering the best patient care. Tight authorization timeframes and rules can also put a tremendous amount of stress on UM teams. And member...
How Can You Deliver Value-Based Care that Engages Baby Boomers?
This post is part of 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 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 driving member engagement and better outcomes. Here, we explore how organizations can improve the delivery of personalized, value-based care at scale for Baby Boomer health populations. What Makes Baby Boomers Unique When It Comes to...
Future of Care Chat – Episode 1 – An Inside Look at 2023
In 2023, we expect to see the continuation of health payers and organizations shifting to value-based care models with a focus on health equity. Combined with the economic headwinds, we’re also expecting to see a higher prioritization on member engagement and activation, addressing social determinants of health, and ensuring optimal data interoperability. Here’s the inside scoop from some of the leaders at VirtualHealth to discuss what we are hearing from clients and in the broader market about healthcare in 2023.
How Can Medicare Payers Better Support Home Health Care?
This is the final article in a six-part series exploring ways to improve the delivery of whole-person, value-based care to Medicare and Medicare Advantage populations. In this post, we cover care management strategies to improve the experience for members who receive home health care services. You can also download our white paper Effectively Managing Medicare Populations: 6 Focus Care Areas to get more information and insights about other areas to improve for Medicare plan members. A significant number of Medicare enrollees require one or more home health services. This may include part-time, medically necessary nursing care, physical therapy, occupational therapy, speech-language therapy,...
How to Improve Care for Medicare Advantage Members with Chronic Conditions
This is the fourth article in a six-part series exploring ways to improve the delivery of whole-person, value-based care to Medicare and Medicare Advantage populations. In this post, we explore strategies to deliver whole-person care for Medicare members with chronic conditions, aiming to improve outcomes and quality of life. You can also download our white paper Effectively Managing Medicare Populations: 6 Focus Care Areas to get more information and insights about other areas to improve for Medicare plan members. According to 2020 data from the Chronic Conditions Data Warehouse (CCW), nearly 32 million Medicare beneficiaries had a chronic condition. And a majority of...
How to Better Address SDOH for Medicare Members
This is the fifth article in a six-part series exploring ways to improve the delivery of whole-person, value-based care to Medicare and Medicare Advantage populations. In this post, we explain how to tackle challenges related to social determinants of health (SDOH) that can prevent members from experiencing optimal clinical outcomes. You can also download our white paper Effectively Managing Medicare Populations: 6 Focus Care Areas to get more information and insights about other areas to improve for Medicare plan members. Healthcare leaders increasingly are recognizing how critical it is to address and incorporate social determinants of health (SDOH) into value-based care models...
Automated Prior Authorization Integration within HELIOS is New Opportunity for Payers
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 in friction between healthcare payers and providers as well as delays in patient care. For years, clinicians have decried the prior authorization process as burdensome and inefficient, with physicians and their staff spending as many as 13 hours per ordering physician per week on request, according...