Turning social risk into measurable financial performance
Payers increasingly recognize that social risk factors materially influence total cost of care, utilization, and quality performance. Yet for many organizations, social risk data remains siloed, underoperationalized, and inactionable. On a recent webinar, MedeAnalytics and Socially Determined demonstrated how health plans can integrate member-level social risk data directly into payer analytics workflows, alongside claims, pharmacy,…
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The GLP-1 Insights Series, Part 2: Maximizing impact and savings through analytics
GLP-1s present a major opportunity for organizations to improve clinical outcomes and reduce long-term healthcare costs. However, payers and providers must balance this potential with challenges such as high upfront spend, adherence issues, and determining which patients will benefit most. Read a more in-depth overview of these considerations in our previous blog post. Managing these…
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The GLP-1 Insights Series, Part 1: Long-term impact on costs and outcomes for payers and providers
Few pharmaceuticals have surged in popularity as fast as GLP-1s. This growth is well-justified. GLP-1s, a class of medications originally developed for diabetes and now widely used for weight management, are rapidly reshaping clinical care with far-reaching impacts on chronic disease management, weight loss, and cardiovascular health. Despite long-term benefits, the prescribing of GLP-1s must…
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Healthcare Data Interoperability: Why Is Healthcare Still Struggling to Share Data?
Key takeaways from The Sequoia Project’s 2025 Annual Meeting to speed up healthcare data interoperability I recently attended The Sequoia Project’s 2025 Annual Meeting in Nashville. The Sequoia Project was formed in 2012 with the launch of its first initiative, a federal health information network. They help healthcare organizations and government bodies accelerate the…
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Helping Accountable Care Organizations Navigate the Perfect Storm
In the ever-evolving landscape of healthcare, Accountable Care Organizations (ACOs) find themselves at the epicenter of a transformative era. Recently, we facilitated an insightful dialogue with healthcare experts Lynn Carroll, COO of HSBlox, and Brian Norris, MBA, RN, FHIMSS, Vice President & Managing Director of Strategic Consulting at MedeAnalytics, to shed light on the future…
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Navigating the Medicare Landscape: Implications of the Latest Rule Changes for Healthcare Organizations
The Centers for Medicare & Medicaid Services (CMS) has recently unveiled significant proposed changes to Medicare Advantage (MA), Medicare Prescription Drug (Part D), and Medicaid programs. Announced on November 26, 2024, these updates aim to enhance affordability, transparency, and equity in healthcare delivery. The implications of the latest CMS rule changes are vast, presenting both…
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Introduction to social risk: What healthcare leaders need to understand
‘Social determinants of health’ has been a common phrase for decades now, but the term social risk is much less popularized. So, what does it mean and is it all that different from SDOH? Most importantly, what should healthcare leaders understand about social risk? Read on to find out. What is social risk? Social risk describes…
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AI is your new crystal ball: How predictive analytics can reduce denials
The idea of having a crystal ball to better understand what claims will be denied is an awesome concept. But one we can’t rely on. Thankfully, we have predictive analytics to take the place of a crystal ball.
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Position your organization for success under CMS-HCC V28
The transition from CMS-HCC V24 to V28 heralds a significant shift in risk adjustment methodologies and emphasizes improved accuracy and granularity, promising more equitable resource distribution and significant financial implications for Medicare Advantage plans, ACOs, and other healthcare entities. If you have not started moving toward this new model, there is no time to waste.…
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Adapting nursing education and practice in a post-pandemic, technology-dependent world
Can AI help reduce nurse burnout? What role should nurses play in regulatory conversations? How do clinical training programs incorporate tech literacy into curriculum? Join a panel of three incredible nursing leaders and technology champions to get answers to these questions and more about the future of nursing! We are honored to welcome new voices…
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