BostInno’s Post

Streamlining intake management is essential, especially in today's challenging times for behavioral health providers. With increased demand and stricter insurance approval processes, efficient patient intake and operations interoperability are crucial. Discover how Concord Technologies is revolutionizing the intake management process in our blog: https://lnkd.in/ek_E6cgc  #IntakeManagement #Referrals #HealthIT #NATCON #NATCON24

We recently conducted an independent survey of over 3,500 healthcare consumers with various types of healthcare plans. Not surprisingly, consumers continue to be concerned about out-of-pocket healthcare costs. Additionally, consumers are demanding increased personalization, better transparency regarding financial responsibilities, and a seamless digital experience from their insurers. Satisfaction was also assessed in areas such as benefits, coverage, personalized support, and preventative care. The report emphasizes that the competitive and dynamic health insurance market is forcing insurers to innovate in member engagement and satisfaction. Consumers' expectations for personalized, high-touch experiences, similar to those in other sectors of their lives, are influencing these trends. The findings underscore the need for health plans to adapt to meet evolving consumer demands.

I had the opportunity along with other payer executives to share advice for future health insurance industry leaders with Becker's Healthcare. My advice to future leaders in the payer industry is to foster and maintain an insatiable curiosity. Embrace the transformative power of technology in healthcare, channel your curiosity into enhancing member and patient experiences, support and enable healthcare providers, and relentlessly seek meaningful solutions to promote healthcare equity for all. Check out the great advice from other executives in this article if you are looking to grow your leadership in the health plan space. #beckershealthcare

I appreciate having the opportunity to join the conversation with Becker's Healthcare. Here are my thoughts: Payers are ground zero for improving a plan participant's healthcare outcomes and overall healthcare experience. Traditional health insurance has evolved into a bureaucratic mess focused more on defending one's turf and pointing fingers than the actual objective, which is helping plan participants get as healthy as possible, as quickly as possible, without going broke. A payer who is willing to build solutions that connect those who want to pay for high quality care with those who want to deliver it, in an efficient and transparent way, have the opportunity to disrupt a stale industry and change the trajectory of healthcare in the United States in a very meaningful way.  #beckershealthcare

Great news in healthcare innovation! Avaneer Health, a Cleveland Clinic Innovations portfolio company, has introduced Avaneer Coverage Direct™, a game-changing platform providing real-time health insurance coverage info to payers and providers. This means smoother operations, improved patient experiences, and streamlined claims management. 🎯 Cleveland Clinic is leading the charge by piloting Avaneer Coverage Direct. The goal? Ensuring precise coverage info upfront to eliminate care delays and financial inaccuracies for patients. 💡 Dennis Laraway, CFO at Cleveland Clinic, emphasizes the transformative impact: "Fewer discrepancies, decreased admin costs, and enhanced patient care—it's a win-win." 💰 The potential savings are significant: $3.35 to $5.75 per claim for providers and up to $1.65 per claim for payers. Plus, with Avaneer Network™, data exchange is secure and efficient. Here's to a future of smoother healthcare operations and better patient care! https://hubs.li/Q02ynFDV0 #HealthcareInnovation #ClevelandClinic #innovationinhealthcare #ClevelandClinicInnovations #healthcare

What if there were CPT codes for delayed, changed, or abandoned care? We’re closer than you think to making that a reality! The AMA is considering issuing CPT codes to better track how prior auths negatively impact patient care workflows. You can register to attend virtually or submit comments in advance. I’ve said it once. And I’ll say it again. WE NEED CHANGE IN GOVERNMENT LEGISLATION TO FIX HEALTHCARE. This is a huge opportunity to quantify the harm payers are incurring on our healthcare system. I encourage you to voice your thoughts. #healthcarereform #priorauthorization

Cigna Healthcare to remove pre-authorization requirement for 25% of medical services. Following in the footsteps of UnitedHealthcare just a few weeks ago. For those not in the health insurance world, pre-authorization is a healthcare cost containment process in which physicians, or other health care providers, must obtain prior-approval from the insurer before a patient can qualify for a specific treatment or drug. Does this change simplify the healthcare experience, or does it create potential challenges for plan mismanagement? Perhaps the answer is somewhere in-between... #healthcarecosts #mcgriffinsights #priorauthorization

TL;DR: The Centers for Medicare & Medicaid Services (CMS) has explicitly stated that health insurance companies are prohibited from using algorithms or artificial intelligence (AI) to deny coverage or determine care for members on Medicare Advantage plans. The CMS memo emphasizes that coverage decisions must be based on the individual patient's circumstances, and AI tools can only be used to ensure compliance with coverage criteria. https://lnkd.in/ehK9GBz9 #AI #healthcare #MedicareAdvantage

My Favorite Slide of the Week Tim O'Leary described a healthcare experience in HuffPost this weekend about stepping into "our country's healthcare hall of mirrors - a convoluted bureaucracy of doctors, insurance companies and clinics designed to create stress". For an industry that exists to reduce suffering, the fact our system unintentionally (but regularly) induces suffering from the lack of coordination, communication, and collaboration is painful. * Doctors don't try to have limited access and little time, they try to provide exceptional care for the person in front of them. * Insurance companies don't try to make rules complex and confusing, they try to keep healthcare affordable. * Hospitals don't try to be impersonal or costly, they try and have cutting edge teams and equipment available in a crisis. I truly believe the only way to solve the issue is to make healthcare human again - understand how all the parts of the system affect the customers/patients using the system. Can people find care, access care, pay for care, and benefit from care across the continuum? Do we coordinate care, passing the baton seamlessly from provider to payer, from office to hospital to home? Today, we focus on (and pay for) inputs to rather than outputs of healthcare: visits, tests, hospital stays. If we focused on measuring and improving outputs (did we make someone's life better because they received care) wouldn't we get farther, faster? My slide of the week is all about thinking from the patient perspective - healthcare should not ever be a hall of mirrors. We have the capacity and the tools needed to reduce suffering - we just need to use them. Medical Results Mix-Up From Doctor Changed My Life | HuffPost HuffPost Personal Press Ganey Thomas Lee, MD Tejal Gandhi, MD David Shapiro Zeev Neuwirth, MD Deirdre Mylod, PhD Chrissy Daniels Joan Kelly Chris Skiffington

The two dumbest words in healthcare: Prior … Authorization (See comments for a wild prior authorization story) You need surgery. Your doctor, with a decade of training agrees. You agree. Your partner agrees. Even your pug agrees. But Blorple from the health insurance company, with 3 months of training, calls you up to say you’re not approved for surgery. The reason: Prior Authorization A non-licensed, non-medical professional, just overruled your doctor because of a typo, or 10,000 page formulary. Let me say that again… Blorple, just made a medical decision about YOU with no medical license. - So what is it and why should you care? Prior authorization, often referred to as "pre-authorization" or simply "PA," is a process used by health insurance companies to determine if they will approve (and subsequently pay for) a prescribed procedure, service, or medication. The decision is based on the medical necessity for the service. Essentially, it means that a healthcare provider needs to obtain approval from the health insurance plan before the plan will agree to cover the cost of the prescribed treatment or medication. Without such approval, the insurance may not pay for the treatment, leaving the patient responsible for the full cost. And there’s the rub. Health insurers allow someone without adequate training to refuse a claim even though only a doctor can assess if a treatment is "medically necessary” and then force you to pay for help. How is it that we live in a country where an untrained laptop-jockey can deny coverage recommended by a physician? How does that make sense? ♻️ Repost if you’ve had a bad experience with health insurance #e #burst #chartstar #healthinsurance #healthcare