health plans
ZeOmega Named #1 KLAS Top Performer for Payer Care Management Solutions 2022
ZeOmega announced that it was ranked #1 Best KLAS for Payer Care Management Solutions 2022. Tweet that “Receiving this top ranking from the highly regarded KLAS organization confirms that we deliver excellence to our customers and illustrates ZeOmega’s unique place in the market as a premier independent solution for a full range of data management …
SyTrue captures healthcare payer market share with suite of NLP-based solutions
STATELINE, Nev., February 1, 2022 /PRNewswire/ — SyTrue, the leader in modernizing payer workflows to reduce costs and increase efficiency, closed a year of phenomenal growth in enterprise customer base, number of employees and volume of transactions. Among the company’s key achievements and milestones in 2021 that cement SyTrue’s dominance in the healthcare market: Excellent …
Editors’ Corner: Top 10 Fierce Health Paying Stories in 2021
UnitedHealth Group announced plans to acquire data analytics firm Change Healthcare in March and since then the nearly $ 8 billion deal has made headlines across the insurance and tech sectors of industry. The country’s largest insurer was among our 10 most-read articles in 2021, representing four headlines and a host of others that were …
ZeOmega Adds Industry Leader to Its Leadership Team to Help Move Payers and Providers to a New Era of Value-Based Care and Data-Driven Quality and Experience
PLANO, TX, December 21, 2021 /PRNewswire/ — ZeOmega®– the healthcare industry’s leading population health management organization – announced today that it has appointed a health plan industry veteran Andy Arend to its management team as Chief Growth Officer (CGO). In the new role, Arends will lead the company’s efforts to help payer and provider organizations …
9 recent extensions of payers, partnerships
Here are nine payers who have expanded their businesses through recent expansions and partnerships: – Managed care organization based in Dayton, Ohio Source of care and health plan sponsored by Mississippi providers TrueCare announced a strategic alliance ahead of TrueCare’s offer to serve Mississippi Medicaid recipients. – Oscar Health added Philadelphia-based Temple Health to its …
Supreme Court to Hear DaVita’s Medicare Secondary Payer Act Case | Rivkin Radler LLP
The United States Supreme Court has agreed to review the scope of the Medicare Secondary Payer Act (MSPA) with respect to the treatment of patients with end-stage renal disease (ESRD). The case to be heard by the tribunal de grande instance, Health Insurance Plan for Employees of Marietta Memorial Hospital c. DaVita, Inc.[1], comes from …
Payvider: Blurring the Lines Between Payer and Provider in Digital Health Offerings | Foley & Lardner LLP
Hosted by the Health Plan Alliance, I was joined by Ken Barrette, Managing Director of Healthcare at Alvarez and Marsal, and Marshall Votta, Operating Partner at Nautic Partners, to discuss the unique opportunities that owned health plans suppliers see by becoming actors. in the technology provider space, as plans abandon their historical roles of risk …
Why Medicare Advantage Plans Must Turn Post-Discharge Care Into Drug-Driven Care Transitions
The 2022 performance year star ratings require Medicare Advantage plans to play a greater role in preventing readmissions. Care transitions have become a major goal in improving the quality of health care and the patient experience and reducing hospital readmissions. Ineffective transfer of a patient from a health care setting (eg, patient dissatisfaction, medication non-adherence, …
WADA Denounces Decreased Payers Competition Amid Growing Antitrust Interest in Washington
Dive brief: U.S. health insurance markets have become increasingly concentrated over the past five years, according to a new report from the American Medical Association, which argues that payor mergers and acquisitions lead to higher costs and fewer costs. ‘care options for patients, but largely excludes the impact of provider consolidation in driving these trends. …
Joining payor networks is key to hospice success in Medicare Advantage
The path to value-based care remains uncertain, but has an impact for palliative care. Providers and payers from all walks of life are taking a closer look at palliative care as the Value-Based Insurance Design Demonstration (VBID) project nears its second year. Hospices need a seat at the negotiating table in order to stay in …
The evolution of pay-supplier networks includes next-generation approaches for better performance in terms of cost, quality and experience
SAN FRANCISCO, September 16, 2021 / PRNewswire / – Join this unique and provocative online discussion at September 29 To 11 a.m. CST, chaired by moderator Richard Lungen, Managing Member, Leverage Health Solutions, and panelists Beth andersen, president of the California Plan, Hymn, Aaron Friedkin, MD, SVP Transforming Care Delivery, Blue Cross Blue Shield of …
CMS delays the application of the pay-to-pay interoperability rule
The Centers for Medicare and Medicaid Services are delaying the enforcement of an interoperability provision that governs how payers are supposed to exchange data with each other, the agency said on Wednesday. “CMS’s decision to exercise discretion to apply the pay-to-pay policy until future regulation occurs does not affect other existing regulatory requirements and the …
Payers’ investment in virtual drug treatment increases
Highmark Health has entered into a new partnership with virtual alcohol use disorder provider Ria Health, following a growing number of insurers looking to expand telehealth benefits for addiction as demand increases. The more than 6 million Pittsburgh-based payor members will now have access to virtual care for alcohol use disorders offered by Ria Health’s …
4 Ways ADT Event Notifications Improve Payor Performance
The new CMS rule for Notification of Admission, Exit and Transfer (ADT) for Conditions of Participation (CoPs) and Shared Risk Arrangements formally entered into force on May 1, 2021. This rule was promulgated to improve the coordination of care between hospitals and the post office. -teams of acute providers, both streamlining and improving communication. It …
Laguna Health Launches New Tool To Help Patients After Discharge From Hospital
Laguna Health launches app to help patients manage their home care after discharge from hospital. The app provides post-discharge patients with access to a 24/7 care team, behavioral care providers and coaches, recovery plans, educational resources and appointments. you by chat or video. Laguna is currently in a clinical trial with NorthShore University HealthSystem in …
Single-payer healthcare system will improve health in the United States
My husband’s parents live in a small town north of Venice, Italy. A few years ago, her father needed a hip replacement. After months of waiting, the date for the operation has been set. As he limped from the car door at the entrance to the hospital, he collapsed. He was loaded onto a stretcher …
Bamboo Health – A Combination of Proven Collaborative Care Leaders – Unveiled to Enable Pay-Provider Collaboration for Whole Person Care | State
LOUISVILLE, Ky. and BOSTON, August 31, 2021 / PRNewswire / – Today, Appriss Health announced its new company name—Bamboo Health-following the acquisition from PatientPing earlier this year. Bamboo Health is focused on creating the nation’s most comprehensive and diverse collaborative care network, connecting every provider and payer to revolutionize all healthcare encounters. Bamboo is a …
Bamboo Health – Combination of proven leaders in collaborative care
LOUISVILLE, Ky. and BOSTON, August 31, 2021 / PRNewswire / – Today, Appriss Health announced its new company name—Bamboo Health-following the acquisition from PatientPing earlier this year. Bamboo Health is focused on creating the nation’s most comprehensive and diverse collaborative care network, connecting every provider and payer to revolutionize all healthcare encounters. Bamboo is a …
USQHIN Launches Payers Advisory Working Group
WASHINGTON, DC, Aug 05, 2021 (GLOBE NEWSWIRE) – The United States QHIN (USQHIN), an innovative national health information network focused on streamlining the exchange of data between states nationwide , today announced the launch of its Payors Advisory Working Group (PATTE). The PAW is a subgroup of the USQHIN National ADT Hub Network (NAHN). The …
Fast forward with Chris Klomp, EVP, Acute & Payer, PointClickCare
In this Fast Forward interview, Home Health Care News sits down with PointClickCare EVP of Acute & Payer Chris Klomp to learn more about the key factors driving the transformation of home health and home care in 2021 and 2022. He also shares his take on where the home health care industry will be in …
Payer Compass Appoints Doug Williams to Board of Directors
PLANO, Texas, June 22, 2021 / PRNewswire / – Payer Compass, a leading provider of healthcare reimbursement technology and price transparency solutions, working with Spectrum Equity, a private equity firm focused on the economy of information, and Health Enterprise Partners (HEP), a healthcare-focused investment firm, today announced the appointment of Doug williams as an independent …
ZeOmega® “Leading” with the highest score of all providers reviewed in the KLAS “Payer Care Management 2021 Performance Report”
PLANO, Texas, June 15, 2021 / PRNewswire / – KLAS Research cited ZeOmega’s industry-leading population health management (PHM) platform Jiva as a leader in payers for configurability, ease of use, Superior API, integration and customer support. The full report can be read here. The KLAS report states, “High performing ZeOmega customers report that the vendor’s …
Quality data, the key to education for hospice-payer relationships in VBID
Leveraging quality data and education when building relationships with payers will be critical to success as hospices will begin to work as part of the Value Based Assurance Design (VBID) demonstration. , often referred to as the Medicare Advantage carve-in hospice. The program started small in its first year, with 53 participating health plans, but …
Valeo Pharma provides an update on the reimbursement of private payers for Enerzair® Breezhaler® and Atectura® Breezhaler®
Private coverage of the payer’s health plan in Canada for Enerzair Breezhaler and Atectura Breezhaler reached 80% Reimbursement procedures with publicly funded health plans ready to start MONTREAL, June 1, 2021 / PRNewswire / – Valeo Pharma Inc. (CSE: VPH) (OTCQB: VPHIF) (FSE: VP2) (“Valeo“or the”Society“), a Canadian pharmaceutical company, today announced that private health …
Building relationships with payers is key to financially sustainable hospice palliative care
According to Anne Tumlinson, CEO of consultancy firm ATI Advisory at the Hospice News Palliative Care Summit, creating and sustaining a financially viable palliative care program will largely depend on a hospice’s ability to demonstrate quality of care. and negotiating reimbursement for these services with payers. . The demand for palliative care has exploded in …
Omega Healthcare Focuses More on Payor Services with New Vice President Chris Rigsby
BOCA RATON, Florida, May 4, 2021 / PRNewswire / – Omega Healthcare, a leading provider of outsourced revenue cycle management and other healthcare support services, today announced the hiring of Chris Rigsby as Senior Vice President-Payer Solutions in charge of extending services to health plans. Omega currently provides risk adjustment, HCC coding and other services …
BrightStar Care targets healthcare system and payer partnerships with latest pilot
Two Chicago-based home care companies are teaming up to illustrate major trends in home care. On Tuesday, BrightStar Care – one of the nation’s largest home care franchisors – announced it was joining Dina’s digital home care coordination network. In doing so, the home care and senior residency franchise organization hopes to improve its ability …
Suspension of 2% Foreclosure Reduction May Affect Repayment of Commercial Payers | King and Spalding
Section 4408 of the CARES Act suspends the 2% sequestration reduction of Medicare program payments that have been in place since April 1, 2013. The suspension of sequestration in Medicare will run from May 1, 2020 to May 31, 2020. December 2020 and will impact both the original Medicare service charges as well as Medicare …
Growth strategies of the main payers
A strong strategy based on innovation and customer service is winning the day, as payers try to make sure not only to keep the customers they have, but to attract new ones in order to be successful. Make connections Tom Wicka, CEO and Co-Founder of NovuHealth, which serves more than 40 healthcare plans in the …
Zuckerberg San Francisco General signs first contract with commercial payer
The San Francisco Health Network – which includes Zuckerberg San Francisco General – has finalized its first contract with a private health plan, according to local mission. Zuckerberg General Hospital in San Francisco has made headlines after a Voice report found that the hospital was out of network with all private health plans, leaving patients …
Deals, the program launches the news of digital health payers in the second quarter of 2019
The digital health-focused moves of payers in the past quarter ranged from partnership deals and program launches to acquisitions and CMS coverage decisions. Several of these headlines came from major players such as Cigna, UnitedHealth Group, Pharmacy Benefit Managers (PBMs) and various Blue Cross plans, and frequently involved digital health stalwarts such as Livongo, Fitbit, …
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Pay Roundup – Uninsured Drop Rates, Rising Hospital Bills Amid Medicaid Colorado Expansion
Medicaid expansion in Colorado: drop in uninsured rate and rise in hospital bills Since Colorado embraced the Medicaid expansion in 2014, St. Mary’s Medical Center has seen some statistics improve, with the number of uninsured patients falling by more than half, allowing the hospital save about $ 3 million per year. However, hospital prices and …
Are your discharge planning failing for patients?
Upon discharge from hospital, uninformed patients often face time-pressed decisions about finding a suitable post-acute care provider. Discharge from hospital to a post-acute care setting is often one of the most daunting challenges patients and their families face. a valued one in five hospitalized patients is referred to post-acute care facilities such as skilled nursing …