Digital as the Differentiator for Biopharma and Medtech

Digital as the Differentiator for Biopharma and Medtech

With the Inflation Reduction Act now on the books, the U.S. Centers for Medicare & Medicaid Services (CMS) will begin negotiating drug prices with the pharmaceutical industry. That, combined with other headwinds such as increased competition from me-too drugs, and ever-present pricing pressure from payers, means that pharma players now more than ever need a new and powerful tool to differentiate their products. We believe the next decade of transformation is digital.
Learning from the auto industry Almost every industry has had to confront a fundamental existential question: What is our product? Consider the automotive industry, which once was largely about hardware…

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Elation Health Buys Medical Billing Company to Create All-in-One Tech Platform for Primary Care Providers

Elation Health Buys Medical Billing Company to Create All-in-One Tech Platform for Primary Care Providers

Elation Health — a San Francisco-based company that sells its electronic health record (EHR) and other technology solutions to primary care providers — on Thursday announced its  acquisition of medical billing firm Lightning MD.
The deal will help Elation become an all-in-one technology platform for primary care offices, CEO Kyna Fong said in a recent interview. Fong founded Elation with her brother in 2010. The siblings grew up in Canada, where their father was a primary care physician — and a passionate one. He was so passionate that he ended up moving his family to the U.S. because he couldn’t “practice the…

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BCBS Tennessee Unveils Health Disparities in First Health Equity Report

BCBS Tennessee Unveils Health Disparities in First Health Equity Report

BlueCross BlueShield of Tennessee unveiled its first Health Equity Report Tuesday, which analyzed six topics of health disparities: behavioral health, cancer, child and adolescent care, chronic condition management, Covid-19 and maternal health.
The report serves as a way to understand the inequities that exist among its members to determine ways the payer can address the disparities, said Dr. Andrea Willis, chief medical officer of BCBS Tennessee. “We wanted to get a better picture of the health issues and barriers to care faced by our members and Tennesseans as a whole, so that we could more effectively partner with health care providers to…

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Experian Health Launches AI-Driven Predictive Denials Management

What You Should Know:– Experian Health launches a new AI-Powered solution, AI Advantage that will help providers recoup the billions in lost dollars due to insurance claim denials. – These new solutions leverage AI and help healthcare providers prioritize their claims reimbursement process and decrease denials overall, saving time and money across the entire healthcare value chain and ultimately improving care and service for patient consumers.AI Advantage[embedded content]One of the top contributors to wasted healthcare dollars is due to the claims process, reported at more than $250 billion per year. Additionally, 35 percent of hospitals and health systems report $50 million or more in…

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KLAS: What Impact Do Automated Prior Authorization Solutions Provide?

KLAS: What Impact Do Automated Prior Authorization Solutions Provide?

What You Should Know:– Prior authorization is mandated by payers to ensure that certain clinical procedures and medications being ordered are necessary. To alleviate the heavy administrative burden this requirement causes, healthcare organizations have adopted automated prior authorization solutions.– For this report, KLAS interviewed 30 respondents from 26 unique organizations to understand their experiences using these solutions and what outcomes they have seen.Understanding the Impact Automated Prior Authorization Solutions ProvideThis report is a perception study designed to help readers understand where the automated prior authorization market is and what outcomes organizations using automated prior authorization are seeing. To gather these perspectives, KLAS…

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Which Moves Should Providers Watch From Amazon, CVS & Walgreens This Year?

Which Moves Should Providers Watch From Amazon, CVS & Walgreens This Year?

Primary care has been historically dominated by traditional providers that deliver care via fee-for-service models, but retail companies have been amping up their efforts to disrupt the space in recent years. Over the next decade, it will become increasingly difficult for hospitals and other traditional healthcare providers to ignore these disruptors, according to a recent report from the American Hospital Association. 
The report cited a Bain & Company analysis that predicted disruptors could own as much as 30% of the $260 billion primary care market by 2030. So what moves by Amazon, Walmart and CVS will the industry need to watch to…

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Few Managed Care Plans Have Current Contact Info for Medicaid Members as Redeterminations Loom

Few Managed Care Plans Have Current Contact Info for Medicaid Members as Redeterminations Loom

Just about one-third of managed care plans have verified or current contact information for between 76% and 100% of their Medicaid members, a recent survey found. 
The news comes as the Medicaid continuous enrollment provision is set to expire March 31 due to the Consolidated Appropriations Act. The requirement was part of the Families First Coronavirus Response Act and banned states from disenrolling people from Medicaid during the public health emergency (although the Consolidated Appropriations Act separated the requirement from the PHE, which will end in May). Starting April 1, states can resume disenrollments and Medicaid enrollees will have to undergo the…

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An inside look at AdventHealth's powerful telemedicine program

An inside look at AdventHealth’s powerful telemedicine program

Most healthcare consumers have experienced certain pain points in receiving care for family and friends.THE PROBLEM
Patient access is a top priority for AdventHealth, a health system based in Altamonte Springs, Florida. For the health system, improving the way it delivers care to patients starts with meeting them at the place of their needs.
“Looking for ways to solve for bringing the right care to the right patient at the right place and time is imperative to stay ahead of the ever-changing landscape,” said Ashley Bard, IT director, care navigation and virtual care technology, at AdventHealth. “In recent years, our users of healthcare…

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CDS Coalition requests FDA rescind final decision support guidance

CDS Coalition requests FDA rescind final decision support guidance

The CDS Coalition is asking the U.S. Food and Drug Administration to pull back on its clinical decision support guidance in order to ensure that the agency better balances its regulatory oversight with the healthcare sector’s need for innovation, while comporting with the statutory language of the 21st Century Cures Act. ‘Flagrant’ disregard for Congressional law and intent
The coalition’s stakeholders – clinical decision support software developers, patient advocacy organizations, clinical societies, healthcare providers and healthcare payers – say the FDA’s guidance exceeds Congress’s statutory definitions of what is considered CDS and threatens to undermine lawmakers’ goals.
“The Office of the National Coordinator for…

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Why NLP can only succeed in healthcare if it caters to caregivers

Why NLP can only succeed in healthcare if it caters to caregivers

Natural language processing, or NLP, is a branch of artificial intelligence that enables machine understanding of human language. In recent years, NLP has become part of consumer products and performs with a sometimes surprising degree of accuracy.Virtual assistants use NLP to understand spoken questions like, “What’s the weather like today?” They can contextualize the meaning of the question, and then use data from online sources to reply with a meaningful response.
Medical NLP has long been a topic of research and development, since it contains significant potential for uncovering meaningful insights from unstructured medical text. This presents huge opportunities for healthcare providers, clinical…

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