Value-Based Care (VBC) is a healthcare model that ties healthcare providers' compensation to the quality, equity, and cost of care they deliver. The model focuses on improving patient outcomes, such as health quality and satisfaction, while also promoting cost-effective care. Providers are...

CMS Interoperability and Prior Authorization Final Rule SynopsisThe Centers for Medicare & Medicaid Services (CMS) changed its prior authorization rules to simplify and digitize the process, and to reduce the burden on each of the three legs in the healthcare delivery tripod: patients,...

Precision Medicine as key driver of next generation personalized health care The term “Precision Medicine” refers to the tailoring of clinical and other health care-related interventions based upon an individual’s unique make-up and circumstances. While personalization of care has long been the...

Part 1: The Current Landscape The remarkable growth in Medicare Advantage enrollment over the past twelve years is raising questions about both the cost and quality of that coverage as well as the ultimate impact on health equity and solvency of the traditional Medicare program. This is the first...

Payment Integrity Evolution Over the past decade, the healthcare industry has seen payment integrity evolve from an under-resourced operational niche to a strategic asset that is central to the overall management of medical expense. A paradigm shift is underway, wherein many payers are recognizing...

Guiding Principles: Payment Integrity as a Strategic Enterprise Solution Today’s technology innovations and workforce challenges (need to drive toward greater efficiency) are prompting payers to take a closer look at payment integrity with an eye toward a more strategic framework. More and more...

Current State of Healthcare Payment Integrity: Article 1 Understanding what healthcare payment integrity entails and why there is renewed interest Payment integrity encompasses efforts on the part of payers and healthcare providers alike to navigate ongoing challenges relative to achieving...

Harnessing the Value of Artificial Intelligence (AI): Protecting healthcare data privacy and security AI at its core encompasses taking advantage of the rich and diverse sources of information that individuals and health care providers amass across the continuum of health-related behaviors,...