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...
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...
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...
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...
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...
Four ways technology supported by artificial intelligence (AI) and the internet of things (IoT) is creating a connected, consumer-driven health industry that enables greater health equity and overall care Sustainability. Transparency. A paradigm shift from reactive acute care to proactive preventive care. These goals are driving big changes in the healthcare industry. They’re part of...
Improving health outcomes and reducing costs of care for Medicare populations may seem like an overwhelming challenge with chronic conditions costing billions each year. After all, these populations are typically older, and with age comes the onset of some of the most common (and expensive to manage) chronic conditions, such as cardiovascular disease, heart failure, hypertension,...
Medicare Advantage (MA) plans have fully embraced whole-person, integrated care and are designed to provide members with much more than traditional clinical healthcare. Many provide additional value-added benefits and services such as dental, vision and hearing coverage, wellness rewards, and transportation to medical appointments. From traditional Medicare Advantage plans to Medicare Advantage plans with prescription...
Why is healthcare data interoperability so difficult to achieve? The technical staff currently needed to manage healthcare data exchange to meet interoperability standards and requirements is extensive, burdensome, and costly. A streamlined FHIR® data solution could significantly reduce all three and help organizations overcome critical data challenges. In the final episode of our data interoperability...
Why does FHIR® matter so much in the modern healthcare data exchange? A conversation with VirtualHealth product team leaders about the different reasons why FHIR®matters in the modern healthcare data exchange. There are a number of reasons why the HL7® FHIR® standard matters in the modern healthcare data exchange. From improved access for payers, providers,...
