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.

Health Plans Encourage Wearables; Few Integrate Data

While health plans encourage wearables, the assessment of the benefits of wearables has been the target of several recent studies. Researches are interested in discovering the “stickiness” of the devices and their effect on wellness program success. The studies note that the Inside employer and payer wellness programs as well as the independent user reflect positively.

Uninsured Numbers Growing In Unexpected Areas, Survey Finds

There was a significant change in uninsured numbers growing for people ages 35 to 49, adults making more than 400 percent of the federal poverty level ($47,520 for an individual and $97,200 for a family of four), and those living in states that have not expanded Medicaid, according to a new Commonwealth Fund survey. Policy fixes like expanding Medicaid in all states, making premium subsidies available to more people, and assisting consumers as they shop for coverage on the marketplaces, the report finds, could address some of the barriers the uninsured face in gaining coverage.

Insurance Coverage Improve Health Outcomes In Four Ways: NEJM

The national debate over the Affordable Care Act (ACA) has involved substantial discussion about what effects — if any — insurance coverage has on health and mortality. Health plans play a leadership role in healthcare reforms. While debate continues, a recent piece in the New England Journal of Medicine answers one main question. Does having insurance coverage improve health outcomes?

CMO-CFO Collaboration Marks Success

It is important to acknowledge that CMOs and CFOs speak different languages, have different perspectives and focus on different goals. It is absolutely critical for clinical and financial leaders to recognize and understand the pain points of their colleagues on the other side of the C-suite. The need for CMO-CFO collaboration is just as evident in the financial realm of health care organizations.

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