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Mississippi Division of Medicaid Establishes Its Second Real-Time Clinical Data Exchange

December 11, 2017 Editorial Team in Big DataClinical Data InfrastructureFeaturedMedeAnalyticsMedicare/Medicaid

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  • What Would the CVS/Aetna Merger Mean for Healthcare?

    November 21, 2017 Editorial Team in FeaturedMedeAnalytics

    Despite the uncertainty surrounding the industry, healthcare mergers and acquisitions, like the proposed CVS Health/Aetna deal, continue to occur. Healthcare is leading other industries in high-grade M&A activity and, according to a PwC report, the health care industry has initiated more than 200 deals per quarter for 12 straight quarters since 2015.

    If the CVS and Aetna deal is approved, the acquisition will be the largest healthcare insurance deal on record based on Aetna’s market capitalization. How could this impact the healthcare industry as a whole? Bruce Carver, associate vice president of payer services, recently connected with Managed Healthcare Executive to share his thoughts. Here are three key implications outlined from the discussion:

    • Impact on Industry Competition – If the merger is approved, healthcare executives will likely need to rethink traditional industry competitors as this would establish market competition against national payer UnitedHealth Group and its ownership of OptumRx.
    • Greater Transparency From Pharmacy Benefit Managers (PBMs) - PBMs have historically been viewed as the drug purchasing middlemen to negotiate lower prices. However, questions have arisen as to whether the savings have actually been passed on to employers and/or consumers. As a result, the market is demanding more pricing transparency. New integrated models, similar to the one created by the CVS and Aetna merger, will help facilitate that transparency.
    • Give Employers and Consumers More Control – By allowing employers and consumers to own more of their healthcare and pharmacy benefits, the industry could save millions. For example, by creating pharmacy benefits that incentivize people with chronic conditions (e.g. diabetes, high blood pressure) to fill and adhere to their medications, the industry could prevent avoidable hospital admissions that cost over $100 billion a year. An integrated insurer, like CVS and Aetna, could establish such incentives.

    To read more insights from Bruce, and other industry experts, check out the full Managed Healthcare Executive articles here and here. If you’re looking for a partner to help your organization manage the shifting healthcare landscape, contact us here.

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  • 2017 Payer Solutions Summit: Bringing Together the MedeAnalytics Payer Community

    November 15, 2017 Editorial Team in FeaturedMedeAnalytics

    From October 25-27, the MedeAnalytics payer community came together at La Cantera Resort and Spa in San Antonio, Texas for the 2017 Payer Solutions Summit. The event gave attendees the opportunity to collaborate to better understand how to keep up with the growth and evolution of the industry, with the support of MedeAnalytics’ solutions and thought leaders.

    Our very own CEO, Paul Kaiser, kicked off the event, introducing himself and discussing his aspirations for the company. Kaiser highlighted how impressed he was with our committed associates, fantastic clients and great technology offerings. He realized how special of a company MedeAnalytics was within the first five months of his new role. Kaiser concluded his presentation by outlining his hopes for MedeAnalytics, which include continuing to evolve, innovate and scale in terms of client value management and transparency.

    In addition to our CEO, Scott Hampel, SVP of product and strategy, and Tyler Downs, CTO, took the stage to discuss product innovation alignment and the payer portfolio. They also explored the company’s technology strategy and plans for growth, including platform innovations, machine learning, guided analysis, third-party integration and more.

    In addition to key thought leaders within the company, several payer clients also delivered presentations that demonstrated their unique use of the MedeAnalytics platform and the results they achieved. Some of the representatives included Mississippi Division of Medicaid, St. Joseph Hospital, part of Covenant Health, Presbyterian Healthcare Services, MVP Health Care, and Kaiser Permanente.

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  • EPM Series: Learn How to Create Organizational Alignment with Performance Management

    November 6, 2017 Editorial Team in FeaturedMedeAnalyticsPerformance Management

    With the shift to value-based care, new payment models now reward organizations that focus on improving quality and lowering costs and penalize those that do not. Under these models, organizations are now required to report on additional metrics and are faced with major time constraints as they try to ensure proper documentation. Because of this, health systems are looking for innovative ways to relieve doctors of their administrative jams and make all parties across the organization more productive. These efforts require a top to bottom initiative, with the organization taking steps to successfully transition to value-based care.

    In this week’s blog, we share how one health system, Jersey City Medical Center (JCMC), part of Barnabas Health, a regional referral and teaching hospital, is driving transparency, communication, results and excellence across their organization by leveraging a Performance Management (PM) solution to ensure they are properly tracking and marching toward their organizational goals.

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  • EPM Series: Providers, Follow these Best Practices to Optimize your Revenue

    October 19, 2017 Editorial Team in FeaturedPerformance ManagementRevenue CycleRevenue Integrity

    With the healthcare industry continuing to shift away from fee-for-service, healthcare organizations still face the challenge of properly tracking all their efforts and ensuring they are being appropriately reimbursed. A recent Healthcare Informatics report noted that:

    “Ongoing changes in both public and private payment are shifting the landscape around revenue cycle management these days, and U.S. physicians and hospitals are facing considerable impacts on their healthcare reimbursement.”

    The report also notes, that healthcare organizations are conducting procedures that are “more complex,” and so are the payments. Now more than ever, organizations need to be laser focused on their billing processes and revenue cycle. The ability to access data is obviously a key factor for success but transforming that data into a strategic plan to tackle revenue remains difficult.

    The challenges around creating plans can come from a lack of leadership accountability, insight into performance metrics, transparency and progress tracking. These factors all play a role in losing sight of tactical actions that drive results. Critical data gets lost in various outlets within the organization which creates a gap between setting goals and achieving them.

    Enter, Enterprise Performance Management, which offers a “closed-loop” system that organizations can use to combine robust data analytics with real-time action planning and progress tracking. Enterprise Performance Management enables organizations to clearly define, track and execute on strategic and operational objectives by empowering employees to track their day-to-day activities with the big-picture strategic plan in mind. For revenue, there are three potential goals to keep in mind:

    1. Increase point-of-service collections - Verify eligibility, confirm demographics and fully understand patient portions after insurance, so your registrars can collect payment prior to service.
    2. Understand denial root causes - Denials come from all parts of the revenue lifecycle. By linking denial trends to their origins, you can resolve errors and oversights that lead to payer rejections and denial write-offs.
    3. Monitor audit risk and reduce take-backs - Improving your financial health isn’t about finding maximum revenue. It’s about finding accurate revenue. By proactively identifying compliance risk areas, you can avoid revenue take-backs and track the audit appeal process.

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