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...
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 ...
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...
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:...
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...
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...
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...
