Articles
GLP-1s present a major opportunity for organizations to improve clinical outcomes and reduce long-term healthcare costs. However, payers and providers must balance this potential with challenges such as high upfront spend, adherence issues,…
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Few pharmaceuticals have surged in popularity as fast as GLP-1s. This growth is well-justified. GLP-1s, a class of medications originally developed for diabetes and now widely used for weight management, are rapidly reshaping…
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Key takeaways from The Sequoia Project’s 2025 Annual Meeting to speed up healthcare data interoperability I recently attended The Sequoia Project’s 2025 Annual Meeting in Nashville. The Sequoia Project was formed in…
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Controlling employee healthcare costs while maintaining a healthy and productive workforce is a top priority for today’s employers. Traditional approaches however are no longer sufficient in the face of rising expenses and evolving…
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In the ever-evolving landscape of healthcare, Accountable Care Organizations (ACOs) find themselves at the epicenter of a transformative era. Recently, we facilitated an insightful dialogue with healthcare experts Lynn Carroll, COO of HSBlox,…
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The Centers for Medicare & Medicaid Services (CMS) has recently unveiled significant proposed changes to Medicare Advantage (MA), Medicare Prescription Drug (Part D), and Medicaid programs. Announced on November 26, 2024, these updates…
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‘Social determinants of health’ has been a common phrase for decades now, but the term social risk is much less popularized. So, what does it mean and is it all that different from…
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The idea of having a crystal ball to better understand what claims will be denied is an awesome concept. But one we can’t rely on. Thankfully, we have predictive analytics to take the place of a crystal ball.
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The dynamic between healthcare providers and payers has historically been quite strained. Though both parties are interested in improving the health of their populations, their approaches to accomplishing that goal are often at…
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The transition from CMS-HCC V24 to V28 heralds a significant shift in risk adjustment methodologies and emphasizes improved accuracy and granularity, promising more equitable resource distribution and significant financial implications for Medicare Advantage…
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