Even though healthcare has spent decades automating processes and digitizing information, both remain remain largely locked in IT silos. There are impenetrable system boundaries between payers, providers, and vendors that reduce efficiency, increase costs, and resist automation. In other words, true interoperability is sorely lacking. From Silos to Services for Value-Based Care reviews the history of interoperability in healthcare and makes a case for how we can unlock the silos, bring information together, and align processes to improve clinical and financial outcomes. Read now or download and read later
Interoperability in healthcare is not just about moving financial and clinical data between payer or provider or moving clinical data from one application to another. True interoperability allows enterprise applications to "talk" and collaborate in a smart, open, and agile manner. The Interoperability Imperative explains what this means; how and why interoperability is necessary to scale complex value-based reimbursement models; and how payers, providers, and vendors can get started. Read now or download and read later
Providers face tremendous pressure to reduce denials. Although many issues can lead to denials, there’s one area that denial management programs can easily overlook: issues related to medical necessity. This white paper focuses on 10 gaps that can cause medical necessity denials and how to address them, from beefing up emergency department case management to improving level of care management. Read now or download and read later
There's no turning back from value-based care and value-based reimbursement. Payers are 58% along the continuum to VBR, up from 48% in 2014. And Providers are now 50% down the road to value. That's according to a national study of 465 payers and hospitals conducted by ORC International and commissioned by McKesson. Yet despite tremendous growth in capitation/global payments, pay for performance, and episode of care/bundled payments, many payers and providers still face obstacles in the transition to value-based care. See where healthcare stands in its journey to value and what it means for the industry in Journey to Value: The State…
Today we announced that eQHealth Solutions has signed a long-term agreement to continue its use of InterQual and CareEnhance Review Manager. eQHealth will use the InterQual evidence-based clinical criteria for its four state Medicaid contacts in addition to its other commercial lines.
Radiology and diagnostic imaging news site AuntMinnie.com covered our recent customer news. We announced that eQHealth will use InterQual evidence-based clinical criteria for its state Medicaid contracts in Florida, Illinois, Mississippi, and Colorado, in addition to its other commercial lines. Read the full story
Today we announced that nearly 500 payers and providers purchased or renewed InterQual®, our flagship evidence-based clinical decision support solution, and related decision management solutions in the first six months of the year. Read the release for the full story.
About 12 million Californians are enrolled in Medi-Cal, the state’s Medicaid program. But many providers find that Medi-Cal claims are challenging to manage, leading to claim denials and lost or delayed revenue. The good news: RelayHealth Financial’s research revealed five actions hospitals can take to improve Medi-Cal claim processing, speed reimbursement, and reduce denial rates. Learn more about these five actions and how to implement them. Read now or download and read later
In its July issue, Health Management Technology magazine asked several industry experts, including our own Nilo Meharabian, about the role and impact of decision support technology in healthcare. Read the web version of the magazine article here.
McKnight's just covered our launch of InterQual 2015, the latest edition of our flagship evidence-based clinical criteria and decision support technology. Read the full article for all of McKnight's coverage.