In speaking with many colleagues throughout the provider and payer healthcare community, I’ve found an overwhelming sense of helplessness to the outbreak’s onslaught. This is exacerbated by the constant evolution of reported underlying medical conditions that indicate a higher risk of hospitalization or mortality for a coronavirus patient.

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By Scott Hampel – I think a lot–and I’m not the only one–about how we can improve the ways we pull information from data. Data on its own is inert: just waiting to be understood and then used. And that’s a major challenge for many organizations. Data is often trapped in different applications with no easy or convenient way to extract it.

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Many challenges face healthcare’s underserved. There are issues with food, housing, reliable transportation, steady employment and more. Each contributes to and is one element of social determinants of health (SDH). In communities around the world, public and private organizations are taking steps to address SDH-related issues and challenges that negatively impact healthcare.

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Every patient has a plethora of data associated with their health record, which can include decades of enrollments, claims, accounts and charges. Much of this data is not housed within the same institutional, facility or provider database…

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MedeAnalytics was recently highlighted in Gartner’s Market Guide for Healthcare Provider Value-Based Performance Management Analytics (VBPMA). As noted in the guide, value-based performance management analytics solutions are the next-generation financial planning and modeling tools that health systems need to manage performance across volume, value, and risk-based contracts.

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Managing the cost and care associated with chronic conditions remains a top priority for both payers and providers. While conditions like diabetes, heart disease, and asthma account for a significant portion of U.S. healthcare spending, they are often preventable or manageable through lifestyle choices, early detection, and proactive care. As a result, the shift to value-based care has prompted healthcare organizations to look beyond chronic condition management and get the bigger picture on factors affecting their patient populations like identifying opportunities for preventative care.

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Value-based care has been top of mind for health systems across the country, but a recent study shows misalignment between payer and provider groups is impacting the industry’s goal of shifting from volume to value. In fact, 62 percent of health plan executives feel that payers have made progress in aligning with providers, while only 41 percent of physicians agree with this notion.

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With the continued frustration over rising healthcare costs, the White House has made prescription drug reform a top priority. Thomas Beaton of HealthPayerIntelligence recently published an article which shares that payers are eager to see this effort succeed as they also search for ways to best address the high prices of certain medications. In 2016, […]

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Following a surge of cesarean section (C-section) operations for expecting mothers, doctors in California must now reduce the number of C-sections performed to 23.9 percent for low-risk births. The state’s health insurance marketplace under the Affordable Care Act, Covered California, wants to curb this rate to improve patient safety and quality. Any hospital that doesn’t […]

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As the health demands of patients expand, payers are increasingly focused on a small segment of their member population that is driving the largest share of healthcare spending: high-cost members. According to the American Health Policy Institute, these high-need, high-cost individuals can cost $100,000 every year, which accounts for one-third of total healthcare spending. As […]

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