Certifi, Inc

The American Medical Association (AMA) released a survey highlighting the negative impacts of excessive prior authorization controls in healthcare. Prior authorization, a tool used by insurers to manage healthcare utilization and costs, is causing harm according to the AMA's survey of over 1,000 practicing physicians. Nearly a quarter (24%) of physicians reported prior authorization leading to serious adverse events, including hospitalization, permanent impairment, or even death. Over 90% of physicians believe prior authorization negatively impacts patient outcomes and delays access to necessary care. 78% reported patients abandoning treatment due to authorization struggles. Over half (53%) of physicians caring for working-age patients reported prior authorization hindering job performance. Learn more: https://hubs.ly/Q02DY1nh0

Driscoll Health Plan, a health insurance provider for Medicaid and CHIP recipients in South Texas, is facing potential closure after the Texas Health and Human Services Commission (HHSC) awarded Medicaid contracts to other insurers. Earlier this year, HHSC awarded the majority of its $116 billion Medicaid and CHIP contracts to Blue Cross Blue Shield of Texas, Molina Healthcare, Aetna, and UnitedHealthcare. Centene, the current dominant provider, received contracts in only three service areas. Driscoll Health Plan, along with several other insurers, challenged the contract awards. However, their protests were rejected by HHSC officials in June. Learn more: https://hubs.ly/Q02DXRFB0

Specialized tools often outperform bundled solutions. This applies to health plans too. Many settle for bundled enrollment and billing software, but dedicated solutions offer significant advantages. Enrollment and billing have distinct complexities. Enrollment software tackles user experience, data accuracy, plan comparison, and eligibility verification. Billing excels at handling transactions, invoicing, payments, and delinquencies. Learn why more health plans are turning to distinct enrollment and billing solutions rather than a combined solution: https://hubs.ly/Q02DX0Rz0

Efficiency is crucial in health insurance member service, but it often overshadows a critical element: empathy. Understanding and sharing a member's feelings is essential for fostering positive experiences and building strong relationships. Members often interact with health insurance during vulnerable times. Whether navigating plans, comprehending diagnoses, or simply dealing with billing, they need to feel heard and understood. Empathy demonstrates that you recognize their challenges and are committed to helping them navigate the healthcare system. Learn how your member services team can foster empathy: https://hubs.ly/Q02DWx0l0

California is taking a big step towards bridging the language gap in healthcare by using AI technology to translate vital documents and resources. Challenges of Medical Translation: - Medical terms can have different meanings depending on the language and cultural context. - Even small errors in translation can have serious consequences for patient care. - Traditional human translation can be expensive and time-consuming. California's Solution: The state plans to utilize AI for faster, more efficient translations across multiple languages. Human editors will still be involved to ensure accuracy and capture cultural nuances. Learn more: https://hubs.ly/Q02CSzv90

The health insurance industry is rapidly evolving. New regulations, technology advancements, and shifting member expectations demand adaptability from health plans. However, many plans are hindered by outdated core administration systems and lack the necessary skills and strategies to compete. This guide outlines key steps to transform your health plan in 2024: https://hubs.ly/Q02sfjgp0

The Medicare Payment and Advisory Commission (MedPAC) released its annual report on healthcare delivery, highlighting ongoing concerns about the completeness of data provided by Medicare Advantage insurers. Key Findings: - While data quality has increased since 2017, MedPAC found the information submitted by Medicare Advantage plans is "generally incomplete." - The percentage of plans reporting complete encounter information across all service categories rose from 80% in 2015 to 96% in 2020. - Data submitted by plans appears to have inconsistencies, raising concerns about its reliability. The commission continues to urge Congress to: - Establish clear standards for complete and accurate data. - Evaluate data submissions and provide feedback to plans. - Withhold a portion of payments from plans that fail to meet data quality standards. Learn more: https://hubs.ly/Q02CSy6s0

AI and other breakthroughs could revolutionize healthcare, but major challenges remain. - AI and similar technologies have the potential to greatly improve patient care and efficiency, but they could also fail to live up to expectations or worsen existing inequalities. - AI-powered tools are already assisting doctors, and gene editing, cell therapies, and brain implants are on the horizon. AI might even predict disease risk. - The current system for testing and approving new medical technologies may struggle to keep pace with the rapid development of these innovations. - These advancements could exacerbate existing disparities in access to care if they become too expensive or exclusive. Experts emphasize the need for proactive measures to ensure everyone benefits from these innovations. Learn more: https://hubs.ly/Q02CSy-m0

A new survey by HealthEdge finds that while most health plan members (86%) are satisfied with their insurers, a significant portion (33%) are considering switching providers next year. This highlights an opportunity for health plans to improve member engagement and loyalty. Key Findings: - The majority of members are satisfied, but competition is fierce with 92% having access to 3+ insurance options. - Members with assigned care managers report higher satisfaction, underlining the importance of personalized support. - 65% of members prefer insurers offering cutting-edge solutions and AI for personalized care experiences. - Long wait times, navigating health coverage, managing prescriptions, and finding health information remain top concerns. - Members prioritize personalized support, preventative care, and clear explanations of benefits. Learn more: https://hubs.ly/Q02CR-bf0

At AHIP 2024, industry leaders discussed how AI is transforming health plans and patient experiences. Here are some key takeaways: - Faster Approvals & Streamlined Workflows: New AI tech is speeding up data exchange and prior authorization processes, reducing administrative burden for both doctors and patients. - Imagine a digital twin that predicts your healthcare needs. AI is making personalized care a reality, allowing health plans to tailor interventions and treatments to individual patients. - AI is poised to revolutionize mental health treatment. Studies show AI can analyze conversations and generate accurate mental health assessments, potentially leading to faster diagnoses and better outcomes. Learn more: https://hubs.ly/Q02CRTNJ0