IMAT Solutions’ Post

Faced with pressure to fix what many in healthcare consider to be a broken process, health plans need to take a data-driven approach to decreasing #priorauthorization response times. In Chordline Health’s latest blog, we discuss why integrating #dataanalytics with prior authorization workflows streamline processes and improve decision-making, leading to better outcomes for patients and better relationships between payers and providers. https://lnkd.in/eKM7Prjk #populationhealth #managedcare

Leveraging healthcare claims data is one way health plan leaders can reduce costs, grow their networks, and enhance outcomes for their members. But what are the strategies for success? We focus on these opportunities in our new three-part series, "Unlocking the Potential of Healthcare Claims Data." https://ow.ly/f82Q50S15Xl #claimsdata #payers #betteroutcomes

Manually sending directory updates to insurers is a burdensome task that costs practices nearly $3 billion each year. It requires physicians to spend hours updating data rather than delivering direct patient care, and it still doesn’t ensure accuracy. Madaket CEO Eric Demers discusses why neutral solutions are needed now more than ever to facilitate accurate provider data exchange in his article at HIT Consultant Media: https://lnkd.in/ePQkDm2v #payers #healthcare #healthtech

Health Data News Roundup: Low Bar for Payers and Value-Based Care; Digital Health Needs to Focus on Outcomes; and the Future of Medicare Advantage #HealthData #Payers #HealthPayers https://bit.ly/4cnohtc

What does the Medicare quality rating change mean for healthcare companies and patient health? Dr. Liz Kwo MD, MBA, MPH, Chief Commercial Officer at Everly Health Solutions, shares strategies for health plans and companies across the healthcare industry in light of the recalculation. Read her piece in MedCity News to learn more: https://bit.ly/468Mn8p #Medicare #StarRatings #Payers #HealthPlans

Just came across this eye-opening article! Inaccurate provider data costs healthcare practices a whopping $2.76 billion annually? That's a staggering amount, and it's not just about money; it's also about the impact on patient care. Imagine if patients can't find the right provider because of outdated information – it could lead to missed opportunities for care and even delays in treatment. It's clear we need smarter solutions to streamline data exchange and ensure accurate directories. Let's work together to make healthcare more efficient and patient-friendly! Read the article here, and let me know your thoughts on it. https://lnkd.in/dJxK4wtW #medmaxtechnologies #providers #healthinsurance #healthcare #healthcarecompliance #patientsafety #worksmarter

In the evolving landscape of healthcare, the integration of STAR quality metrics and ratings with Medicare Advantage payers is more critical than ever. These metrics not only guide patient care but also have significant implications for the financial outcomes of Accountable Care Organizations (ACOs) and primary care practices. Incentivizing High-Quality Care: Medicare Advantage plans often tie reimbursements to quality metrics, encouraging ACOs and primary care practices to prioritize patient-centered care and preventive services. This leads to better health outcomes and higher patient satisfaction. Financial Performance: Meeting or exceeding quality benchmarks can result in increased reimbursements, while failing to meet them can lead to penalties. This financial incentive drives practices to improve care processes and outcomes, directly impacting their bottom line. Data-Driven Decision Making: Quality metrics provide valuable insights into patient populations, enabling providers to identify areas for improvement, allocate resources effectively, and implement targeted interventions that enhance care quality. Risk Management: ACOs that focus on quality metrics are better equipped to manage risk. By proactively addressing patient needs and preventing complications, they can reduce hospitalizations and associated costs. Strengthening Partnerships: Collaborating with Medicare Advantage payers on quality initiatives fosters stronger relationships and opens up opportunities for shared savings programs, benefiting both parties. As we continue to navigate the complexities of value-based care, embracing quality metrics is essential for the sustainability and financial success of ACOs and primary care practices. #Healthcare #MedicareAdvantage #QualityMetrics #AccountableCareOrganizations #ValueBasedCare #PrimaryCare 4o mini

CommonSpirit's financial struggles from claim denials and delayed payments highlight the growing burden on health systems, despite efforts to increase patient volumes and lower labor costs. Payers continue to shift costs onto providers, leading to operational losses. At PayerWatch, we recognize these challenges and work aggressively to help healthcare systems recoup rightful revenue. Our team is committed to addressing these payer obstacles with innovative solutions, ensuring that providers are compensated fairly for the critical care they deliver. Health systems deserve a partner who understands their pain and fights alongside them. https://lnkd.in/g3mYVurC

CCM Engagement Rates (cont'ed) The views are mine. As per Sai Ma's question, I included two "Complex" Chronic Care Management (CCM) codes in the previous analysis [1]. In the original post, I looked at the non-complex CCM and found that the average months per beneficiary on CCM have been trending up. This time, I looked at three CPT codes, including the "complex" CCM codes. Specifically, 1. 𝟵𝟵𝟰𝟵𝟬 (𝗻𝗼𝗻-𝗰𝗼𝗺𝗽𝗹𝗲𝘅): Chronic care management services, first 20 minutes of clinical staff time per calendar month 2. 𝟵𝟵𝟰𝟴𝟳 (𝗰𝗼𝗺𝗽𝗹𝗲𝘅, 𝙣𝙚𝙬𝙡𝙮 𝙖𝙙𝙙𝙚𝙙 𝙞𝙣 𝙩𝙝𝙞𝙨 𝙥𝙤𝙨𝘁): Complex chronic care management services, first 60 minutes clinical staff time per calendar month 3. 𝟵𝟵𝟰𝟴𝟵 (𝗰𝗼𝗺𝗽𝗹𝗲𝘅, 𝙣𝙚𝙬𝙡𝙮 𝙖𝙙𝙙𝙚𝙙 𝙞𝙣 𝙩𝙝𝙞𝙨 𝙥𝙤𝙨𝙩): Complex chronic care management services each additional 30 minutes clinical staff time As can be seen, the average months per beneficiary on the complex CCM program are also trending up, although 99489 had a bit of ups and downs. Note that 99489 is used on top of 99487, so we need to interpret the result a bit differently. What's really going on with CCM? Are care teams getting better? There are many ways to look at the trend in the chart below. Analyzing publicly available data requires more effort, but it still provides interesting insights about the market. When I have time, I will try to go deeper into this. The same Centers for Medicare & Medicaid Services dataset is used for the chart. [1] https://lnkd.in/ePA7899q #valuebasedcare #ccm #chroniccaremanagement #virtualcare #healthcareanalytics

Potentially Preventable #Readmissions (PPR) pose a significant challenge in #healthcare, not only in terms of members outcomes but also in terms of financial implications. According to a 2021 report by the Agency for Healthcare Research and Quality (AHRQ), #medicare readmissions totalled a staggering 2.3 million per year, with an average cost of $15,500 per readmission. On average, this comes out to roughly $500 per year in PPR costs for every Medicare member that a health plan manages care for – we’ll leave the rest of the math to you. #CentaurDataPlatform 's transformative impact extends to healthcare analytics, allowing Health Plans to move beyond traditional, disjointed approaches to data processing and utilization. By leveraging ADT message data alongside other critical healthcare information from FHIR and non-FHIR sources, Health Plans can gain a comprehensive understanding of patient trajectories, identify potential risk factors, care disparities and implement timely strategies to reduce risk, prevent readmissions, etc. Read more about how Health Chain is using ADT Data to reduce avoidable admissions for several Health Plans. https://lnkd.in/gRKSCmfW #HealthChain #Payers #Readmissions