Members Want Provider Networks With Strong Online Presence

Medical review is the collection of information and clinical review of medical records by physician advisors (for providers reviewing cases before submissions) or a peer review team (for payers) to ensure that payment is made only for services that meet coverage, coding, and medical necessity requirements. Here are 10 instances which can help you better identify when its time to look for a partner.

Healthcare Consumer Engagement Gap With Payers: They Want…?

Change Healthcare (CH) announced payer insights revealed in The Engagement Gap: Healthcare Consumer Engagement in 2017, a new national study of 89 payers, 251 providers, and 771 consumers. CH asked payers about the factors influencing their consumer-centric initiatives, and how these strategies are altering their organizations. Health plans surveyed were generally aligned in pointing to value-based care as the primary factor driving their focus on consumer-centricity, with 74% reporting it as the leading factor.

Health Plans Hit New Low: 360° View Of Trust In Healthcare

Findings from the 11th Annual ReviveHealth Trust Index™ reveal trust in healthcare is dismal across the board, and trust in health plans hit new low. The survey represents the first 360-degree view of trust in healthcare – digging into consumer, physician, health plan, and health system executives’ views of each other – showing the industry as a whole has a long way to go. Factors driving widespread distrust in health plans by provider organizations include the hassle of doing business with payers and a lack of progress toward new models of payment and care. Consumers feel slighted by health plans as well, compared to the higher trust ratings in physicians and hospitals.

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