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The True Cost of ACO Patient Leakage

The True Cost of ACO Patient Leakage

Accountable Care Organizations (ACOs) — the providers, health systems and their supporting payer networks who join forces to achieve better quality care and lower healthcare costs — are...
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Payer Strategies In The Time of COVID-19, part 3

This is the third part of a three-part series on strategies for payers during the COVID-19 pandemic.   
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Payer Strategies In The Time of COVID-19, part 2

This is the second part of a three-part series on strategies for payers during the COVID-19 pandemic.   
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Payer Strategies In The Time of COVID-19, part 1

This is the first part of a three-part series on strategies for payers during the COVID-19 pandemic.   
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We've all been there...

We’ve all been there…sitting anxiously in our PCP’s office waiting for the result of some routine tests. As the doctor comes back with the results, you hope he or she is going to say, “you’re good to...
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How Care Navigators can help payers close care gaps and improve HEDIS scores

The Healthcare Effectiveness Data and Information Set (HEDIS) is used by more than 90% of healthcare payers as a means to assess their performance. HEDIS is important to payers because it impacts...
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OIG report details common tactics used by top ACOs to save cost while improving care

The Office of Inspector General (OIG) recently reported on key tactics shared by the top 20 ACOs who are returning savings to Medicare under the Medicare Shared Savings Program.
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Scribes for the Win!

Medical scribes have become an integral part of the medical landscape.  By 2019, there will be 100,000 medical scribes, roughly 1 for every 9 physicians.
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The Burden of Prior Authorizations

Prior authorizations are one of the myriad of examples of inefficiency, bureaucracy and red-tape that bogs down our healthcare system. Unfortunately, prior authorizations are not going away. This...
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What is a referral?

In healthcare, a referral is commonly defined as the act of directing a patient to a medical specialist. However, that definition is too simplistic. A better and more comprehensive definition is the...
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