Certifi, Inc’s Post

Value-based care is taking center stage in healthcare, but how do we truly measure its success? Don Antonucci, CEO of Providence Health Plan, argues that current discussions often overlook key aspects. While affordability is a crucial element, Antonucci emphasizes the need for a more comprehensive approach. He highlights three often-missed dimensions: - Accessibility: Value-based care should ensure patients have access to the right care, not just any care. - Provider Experience: The model should consider the experience of doctors, nurses, and other healthcare providers. - Patient Experience: Ultimately, value-based care should translate into a positive experience for patients. Learn more: https://hubs.ly/Q02DYm_M0

Risant Health, a non-profit subsidiary of Kaiser Permanente, announced the acquisition of Cone Health, a North Carolina-based health system. This news follows Risant's recent purchase of Geisinger, making Cone Health their second acquisition. Risant Health aims to create a network of healthcare providers focused on value-based care, a model that prioritizes patient outcomes and cost-efficiency. Learn more: https://hubs.ly/Q02DXV0-0

Health insurance billing involves significant complexity and requires accurate, efficient solutions. Many health plans rely on outdated internal systems or limited core admin billing solutions. These lack the functionality for optimal billing management. Cloud-based solutions can be advantageous for the following reasons: - Accessible from anywhere with an internet connection, allowing remote work and improved responsiveness. - Cloud solutions adapt to changing needs, scaling up during peak billing periods and down during slower times. This eliminates the need for expensive hardware upgrades or software licensing changes. - Cloud vendors like Certifi constantly update their platforms, ensuring access to the latest features without manual installations. - Cloud providers invest heavily in security measures, employing encryption, firewalls, and intrusion detection systems. Regular audits and certifications ensure adherence to industry standards. Data backups add another layer of protection. - Cloud-based software integrates with existing systems, streamlining data flow and eliminating manual data entry. This reduces errors and improves data accuracy. Learn more: https://hubs.ly/Q02B5wsx0

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