The Next Era of Payment Integrity: Earlier Clinical Validation, True Transparency
By using AI-powered intelligence to shift clinical and coding validation earlier in the healthcare continuum,…
The Next Era of Payment Integrity: Earlier Clinical Validation, True Transparency
By using AI-powered intelligence to shift clinical and coding validation earlier in the healthcare continuum, and unlocking upstream clinical data to inform downstream payment workflows, organizations can proactively prevent errors, reduce downstream churn and friction, and support more predictable, accurate, and timely payments. The post The Next Era of Payment Integrity: Earlier Clinical Validation, True…
Revenue Isn’t the Signal: What Early-Stage Health Tech Investors Should Be Watching Instead
What matters just as much — if not more — is everything around that number: how customers adopt the product, how sales actually happen, and whether the company is building something that can scale inside a complex, regulated system. The post Revenue Isn’t the Signal: What Early-Stage Health Tech Investors Should Be Watching Instead appeared…
Why KFF Is Launching a Podcast on the Business of Health
To kick off KFF’s Business of Health with Chip Kahn, KFF’s Drew Altman explains how KFF is continually evolving to research, analyze and lead on health policy. Chip and Drew discuss how KFF’s new podcast will break down the business side of health care, artificial intelligence, and what it all means for health care delivery…
Real Estate Investors Profit From Long-Term Care While Residents Languish
By the time she was hospitalized in 2020, Pearlene Darby, a retired teacher, had suffered open sores on both legs, both hips, and both heels, as well as a five-inch-long gash on her tailbone. She died two weeks later at age 81 from infections and bedsores, according to her death certificate. Her daughter sued the…
Democrats Demand Trump Administration Halt Plan To Collect Federal Workers’ Health Data
Democratic lawmakers are demanding that the Trump administration halt plans to collect sensitive medical records for millions of federal workers and retirees, as well as their family members. The Office of Personnel Management has asked 65 insurance companies to provide monthly reports with detailed medical and pharmaceutical claims data of more than 8 million people…
Listen: Cheap Health Insurance Isn’t Always Cheap
High-deductible plans can look like a deal, until the bills start rolling in. On this episode of the NPR podcast Life Kit, reporter Jackie Fortiér breaks down what to expect and how to prepare. A lot of people choose their health insurance the way they shop for a flight — sort by the lowest price…
Philippe Pouletty, Carvolix
Philippe Pouletty is a physician who’s an inventor, French venture capitalist, and the founder of Carvolix. Carvolix is a medical technology company that is introducing AI into cardiology. Before Carvolix, Philippe was the founder of Abivax, which makes drugs for chronic inflammatory diseases like ulcerative colitis. He’s been working on helping French medical products develop…
Policy Expert Believes CMS is Taking “Adversial Posture” to Medicare Advantage
A consultant who has analyzed healthcare policy over many decades declares that MA is in the middle of a fundamental reset both in terms of market headwinds and federal scrutiny. The post Policy Expert Believes CMS is Taking “Adversial Posture” to Medicare Advantage appeared first on MedCity News.
UnitedHealthcare Expands Rural Healthcare Initiatives, Reduces Prior Auth Requirements
UnitedHealthcare is exempting rural providers from most prior authorization requirements. The post UnitedHealthcare Expands Rural Healthcare Initiatives, Reduces Prior Auth Requirements appeared first on MedCity News.
What is the purpose of cost sharing for cell & gene therapies?
This is the question that a recent AJMCcommentary by William Shrank, Ellen Kelsay, and Mark Fendrick aims to answer. When talking about cell and gene therapies, the authors argue that cost sharing is not being used to avoid unnecessary use of low value care, but rather as a form of rationing that creates disparities in…
