Healthcare Strategies

Introducing Generative AI to the Health Insurance World

While artificial intelligence (AI) is not new to the payer industry, generative AI has generated quite the buzz. Ginny Whitman, senior manager of public policy at Alliance of Community Health Plans (ACHP), discusses how payers have reacted to the new tool, how regulatory trends might shape its future, and more.

Industry Perspectives: Defining, Achieving Value-Based Care Enablement

Moving through the value-based care world can be difficult for providers. Jean-Claude Saghbini, president of value-based care enablement at Lumeris, shared what value-based care enablement looks like and how improving data-sharing between stakeholders can reinforce the relationships that are indispensable to value-based care success.

Headlines: Physician-Owned Hospitals Save, 2023 Employee Costs Soar

Today on Healthcare Strategies | Headlines: Physician-owned hospitals see huge savings compared to traditional hospitals. Average employee premiums and deductibles increased substantially in 2023. Meanwhile, eLearning for electronic health records training could reduce provider burnout, and one hospital is prescribing--and delivering--lower utility bills.

Empowering Diabetes Care with CGM Education

In this episode of Healthcare Strategies, Senior Editor Alivia Kaylor chats with Tina Platania, PharmD, Director of Clinical Services at CCS and a certified diabetes care and education specialist, about the role of healthcare providers in continuous glucose monitoring (CGM) coaching and education. CGM has emerged as an essential tool in diabetes management, revolutionizing how healthcare professionals and patients approach the disease. Platania offers valuable insights into the significance of CGMs and their impact on personalized diabetes care.

Headlines: Major Strike Ends, New Ransomware Emerges

Kaiser Permanente and striking unions reached a tentative deal after the country's largest healthcare strike. Also, the FDA will set up a Digital Health Advisory Committee, HC3 warned of a new ransomware targeting healthcare, and Medicare Advantage plans' 2024 star ratings dropped again.

Maintaining Value-Based Care Momentum in Accountable Care Orgs

The transition to value-based care has been a marathon, not a sprint. However, health systems like Advocate Health have seen success by diving into the world of value-based care. Megan Reyna, MSN, RN, system vice president for enterprise population health at Advocate Health, discusses how to overcome barriers to adoption, technology’s role, and the opportunities of value-based care. 

Headlines: Historic Healthcare Strike Looms, Hospital Operating Margins Rise

Kaiser Permanente employees are preparing to strike as workforce shortages, clinician burnout, and low wages drive healthcare workers to extreme measures. Meanwhile, hospitals have seen six months of an upward trend in median operating margins, and NIH invests in AI research for kidney transplants.

Assessing Health Benefits to Ensure Equity in Affordability

For women, health benefits are worth over $1.3 billion less than for men. This results in higher out-of-pocket spending among women and increases the financial gap between the sexes. Andy Davis, principal for Deloitte Consulting LLP’s Health Care practice, and Marielle Farina, senior manager at Deloitte Consulting, discuss this imbalance in health benefits equity and what employers and health insurers can do about it.

Headlines: Biden’s Medical Debt Ban, Costco Breaks Into Virtual Care

On the federal level, the Biden administration is proposing banning medical debt from credit scores, CMS paused Medicaid redeterminations for 30 states, and the Federal Trade Commission is cracking down on major anesthesiologists in Texas. Meanwhile, Costco is entering the virtual care space with a new partnership and the Texas Tech University Health Sciences Center will launch an institute dedicated to rural health and digital health.

Using Predictive Analytics To Bolster ACOs’ Value-Based Care Initiatives

As US healthcare continues to move away from fee-for-service and toward value-based care, accountable care organizations are tasked with driving much of that shift through high-quality care management and population health management initiatives. Sheila Magoon, MD, executive director of Buena Vida y Salud ACO and the South Texas Physician Alliance, and David Clain, chief product officer at the Health Data Analytics Institute, explore how predictive analytics and digital twins can help ACOs achieve their value-based care goals.