What is FHIR? Why does FHIR matter in healthcare data management? The HL7 FHIR (Fast Healthcare Interoperability Resources 1) standard defines how healthcare information can be exchanged between different computer systems regardless of how it is stored in those systems. And for healthcare payers and organizations today, it’s an important standard for sharing and exchanging clinical records across the care continuum so as to enable cost-efficient care, and the standard by which healthcare organizations are held accountable. This includes those under the banner of CMS for data related to healthcare services, prior authorizations, and more. In Episode 3, Marcus Caraballo,...
How Can Accountable Care Organizations Address the Data Silo Challenge?
Nearly a decade ago, a Forbes contributor referred to data silos as “a medical tragedy.” Jump forward 10 years and we still have data silos. And the very real human consequences they create such as suboptimal health outcomes related to missed or delayed diagnoses, medical errors, and missed opportunities to provide the right care at the right time. Although data sharing presents significant challenges for accountable care organizations (ACOs), there are strategies that can help address data silos, including instilling a collaborative work culture and adopting technology that enables seamless data integration across ACOs. Why ACOs Need to De-Silo Their...
6 Things Accountable Care Organizations Should Look for in a Medical Management Platform
Medical management platforms can help accountable care organizations (ACOs) meet core goals related to providing highly coordinated, value-based care. For example, software with automated workflows and data centralization capabilities helped ACOs increase primary care services and wellness rates among members while reducing emergency department visits, hospital readmissions, and overall costs, according to a 2017 report in Healthcare IT News. But, with many medical management platforms in the market now, which is right for your organization? Medical Management Software for ACOs: 6 Critical Considerations An ACO should look for a medical management platform that provides the tools and resources to cost-effectively...
Future of Care Chat – Episode 2 – The Evolution of Healthcare Data Interoperability
How has healthcare data interoperability changed in the last few years? Are data silos still a core challenge? Disconnected data negatively impacts payers and providers across the care continuum, impacting everything from healthcare experiences and health outcomes to higher costs and inaccurate care and utilization management. In Episode 2, Marcus Caraballo, VP of Product Management, and Huthaifa Khan, Director, Solutions Architecture, discuss how healthcare data interoperability is evolving to address common pain points and challenges.
Three Essentials a Value-Based Care Management Platform Must Have
Your patients (health plan members) are the driving force behind everything you do. And with the gradual shift over the past two decades from volume-based, fee-for-service payment models to value-based care and managed care models, your team is finally able to focus on each patient as a whole. The only thing that could possibly get in your way? Spending too much time on the administrative responsibilities behind care management. Fortunately, there are solutions that can help improve the quality of individuals’ health outcomes and increase care team efficiency at the same time. Moreover, this efficiency also results in reduced staff burnout....
How Healthcare Payers Can Unlock More Effective Motivational Interviewing
Healthcare payers can help members improve health choices with digital tools and key motivational care management strategy Motivational interviewing (MI) is an evidence-based method of helping members overcome resistance to positive behavior changes that are critical to improving their health. Through effective MI, care managers can empower members to Identify personal barriers to better health choices and behaviors Increase the likelihood of successful behavior changes Improve adherence to care plan instructions or medication regimens Achieve better clinical outcomes and quality of life Despite these benefits, carrying out effective MI can be challenging for some care teams. Find out how healthcare...
Pediatric Populations: How Can Care Managers Engage Families with SDOH-Related Needs?
A national survey of parents with children under the age of 18 found that: 32% missed at least one pediatric medical appointment in the last year because they were unable to get to it or pay for it. 30% reported not having enough time to focus on their child’s health unless it’s a medical emergency. 23% were experiencing food insecurity. Despite their best efforts and intentions, care managers sometimes encounter barriers when trying to engage families of pediatric members facing these and other social determinants of health (SDOH). How SDOH Needs Impact Family Engagement and Outcomes As the study referenced...
Why Should Healthcare Payers Consider Integrated Utilization Management Technology?
Drive faster authorizations, reduce human error and administrative burden, and get higher plan satisfaction ratings As value-based care models continue to grow in popularity, healthcare plans and providers should take this opportunity to consider holistically transforming their utilization management (UM) program approach. Historically, utilization management and care management have been separate disciplines with separate data. This siloed approach can result in higher costs, more administrative effort, slower care delivery, and poor member experiences. HELIOSum, which was recently launched in 2022, simplifies the entire utilization management process. The Quick Benefits of HELIOSum A cloud-based solution, HELIOSum unifies providers, care managers, and...
How Can You Deliver Value-Based Care that Engages Generation X?
This post is the third 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 individual non-clinical factors that impact health, is integral to driving member engagement and better outcomes. Here, we explore how organizations can improve delivery of personalized, value-based care at scale for health care payers managing populations with Generation X members. These are the health plan members either on a commercial employer health plan or aging into Medicare. At a Glance: Top Health Concerns of Generation X...
Future of Care – Episode 10: The Connected Care Ecosystem in 2024
Enabling a whole-person care approach that benefits members, payors, and providers From member-centered, whole-person care to driving cost savings, better coordination of care, and more efficient processes, this is all part of the connected care ecosystem. Join Robert McChane, VP of Marketing, and Katie Nieto, Senior Program Manager, in our latest Future of Care Chat episode about creating a connected care ecosystem and why this matters for #healthcare payors focused on value-based care.