Legacy EHR, billing and accounting systems are based on a fee-for-service model and don't adequately support value-based purchasing and alternative payment models, says Brian Wheeler, vice president of provider collaboration and network transformation at CareFirst BlueCross BlueShield. Advanced analytics and partnerships with health care providers help bridge the gap, Wheeler says, and a report from Bailit Health said multi-payer alignment also helps.
Anthem and Humana will take minority stakes in DomaniRx, a joint venture with SS&C Technologies to develop a cloud-based pharmacy claim adjudication platform, according to a Securities and Exchange Commission filing. "The insights we will draw from hundreds of millions of claims transactions, powered by DomaniRx's advanced processing platform, will provide participating members flexible tools, advanced analytics, and customizable programs," said SS&C General Manager Danny Delmastro.
Connie Health announced plans to offer its Medicare health plan navigation platform in Texas and expand in Arizona. The artificial intelligence-powered platform matches consumers with Medicare plans that best meet their needs, lets them enroll online or through a local agent, helps them find available health care providers and guides them through their chosen plan's benefits.
Highmark Health's Lumevity business consulting subsidiary has begun offering business consulting services to other Blue plans, hospitals, health systems and employers. Lumevity uses machine learning and other technology to streamline administrative tasks like claims processing, potentially giving clinicians more time to spend with patients, says co-founder Marcus Johnson.
Aetna's Better Health of Kansas Medicaid program is working with other Kansas Medicaid administrators and CKF Addiction Treatment on a virtual substance abuse screening platform for use in primary care settings. The platform includes videoconferencing, referrals and access to outpatient services facilitated by licensed counselors and certified peer mentors.
The CMS said it will not remove Affordable Care Act tax credits for health insurance purchased through the federal or state exchanges for the 2021 and 2022 plan years, without filing tax returns and reconciling their premium tax credits. The guidance, released last week, is intended to ensure health care coverage remains affordable through the pandemic.
Premiums for health insurance plans offered on Covered California, the state's Affordable Care Act exchange, will rise by an average of only 1.8% for the 2022 plan year, despite an average 6% increase in health care costs, says Covered California Executive Director Peter Lee. Total enrollment through the exchange is around 1.6 million, and the average monthly premium after tax credits is $100.
White papers and case studies submitted by our Affiliate Organizations (AOs) bring you the latest thinking on current topics in health care. This week's features include Blue Eagle Consulting on choosing a health IT partner; BVK on their brand + demand strategy; Wolters Kluwer on natural language processing; and Ovia Health on behavioral interventions to encourage healthier mothers and babies.