2025 Payer Trends: Navigating Complexity, Compliance, and AI Disruption
By Chris Rigsby, SVP Payer Solutions For payers, 2024 was a challenging year. Sweeping policy changes squeezed reimbursement, and rising medical utilization sent costs soaring. Managed care stocks underperformed significantly, plummeting 13 percent and lagging far behind the S&P 500’s 23 percent growth, as investors reacted to worsening margin pressures and growing regulatory scrutiny. […]
4 Ways Empowering Providers Optimizes Risk Adjustment for Payers
By Chris Rigsby, SVP Payer Solutions In an ideal world, risk adjustment begins with quality patient care. Patients actively participate in routine wellness visits and can easily access the healthcare services they need. Providers have plenty of time and energy for every patient they assess. Documentation is consistently captured during every visit, offering a complete […]
Healthcare Trends 2023: A Year in Review
What healthcare leaders and executives need to know Anurag Mehta, Co-founder and Chief Executive Officer, Omega Healthcare Healthcare leaders across all sectors are still struggling after the COVID-19 pandemic. Organizations have been navigating challenging waters, from labor shortages to inflation to supply chain interruptions and plummeting consumer trust. Below are three key healthcare challenges that […]
How HCC Coding Reviews Help Optimize Reimbursement and Improve Outcomes for High-risk Populations
HCC Coding Reviews Help Improve Coding Quality, Care Plan Efficacy, Outcomes, and Reimbursement Just 5% of the nation’s population accounts for close to half of all healthcare spending with the top 1% incurring more than $130,000 a year in healthcare costs.[1] What’s driving this disparity? One reason is the increase in chronic diseases among Americans. […]
CMS RADV Final Rule is Here: How to be Proactive
The Increased Scrutiny Presented by the RADV Final Rule Requires Providers to Remain More Proactive with their Health Plans and Collaborate Better Providers and payers must work together to minimize the impact of takebacks and improve the health of members. The long-anticipated final rule governing Risk Adjustment Data Validation (RADV) audits was issued January 30, […]
How Risk Adjustment Coding can help Optimize Revenue and Improve the Patient Experience
Provider Education is Key to Improving Risk Adjustment Coding Compliance Lack of collaboration and friction between payers and providers has been a problem for decades. Before high-deductible health plans, most of the behind-the-scenes administrative processes—where much of the conflict resides—were of little concern to consumers. Now that those consumers are responsible for more of their […]