Healthcare Strategies

Bringing artificial intelligence into prior authorization processes

There are many eye-catching artificial intelligence use cases out there, but in today's episode we focus on one AI opportunity that impacts a large swath of the healthcare system: prior authorizations. What can AI do to alleviate provider burden related to prior auth?
 
Featuring: Amber Nigam, CEO and co-founder of basys.ai
 
In today’s episode, we’ll cover…
The challenges of the prior authorization process
How artificial intelligence can reduce provider burden
What prior authorization might look like in the future
To learn more about artificial intelligence, check out our site Healthtech Analytics.
 
To watch video clips from our podcast, subscribe to our YouTube channel, @HealthcareStrategies.
 
Read More
Impact of prior authorizations on health insurers: https://www.techtarget.com/healthcarepayers/answer/With-Proper-Use-Artificial-Intelligence-Improves-Health-Plan-Operations 
Revenue cycle strategies for reducing friction in prior authorization: https://www.techtarget.com/revcyclemanagement/answer/From-AI-to-Regulation-Making-Progress-with-the-Prior-Authorization-Process 
Transparency in prior authorizations: https://www.techtarget.com/healthcarepayers/feature/Overcoming-Tech-Barriers-to-Achieve-Prior-Authorization-Transparency 

Exploring chronic disease management trends, strategies

Chronic disease management and prevention strategies are of increasing importance as chronic conditions increase in prevalence.
 
Guests: Sara Heath, executive editor at Xtelligent Healthcare
Alivia Kaylor, senior editor, Pharma Life Sciences at Xtelligent Healthcare
Anuja Vaidya, senior editor, Virtual Healthcare, and special events lead at Xtelligent Healthcare
 
In the first episode of Season 6, we'll cover
Patient engagement strategies to improve chronic disease management
Using digital health tools for expand chronic disease prevention
The role that clinical trials play in chronic disease...
and more!
 
References
100 million people lack primary care access
Impact of caregivers on patient outcomes
Impact of insurance status on screening rates
Efficacy of digital health tools for diabetes
Social determinants of health resource tool
 
To learn more about chronic disease management from different angles, check out our Patient Engagement site, Pharma Life Sciences site and Virtual Healthcare site.
To watch video clips from the conversation, subscribe to our YouTube channel, @HealthcareStrategies.

Industry Perspectives: Bridging gaps to control drug costs

Leaders in some healthcare organizations, like today's guest, are trying to bridge the gap between stakeholders to achieve a common goal: lowering drug costs for patients. Why do drug costs have such a high impact on overall healthcare spending and what can healthcare organizations do about it?
Guest: Cynthia Meiners, senior vice president and strategic program development officer at GoodRx
In today's episode, we'll cover
Prescription drug spending trends
Alignment among healthcare stakeholders around decreasing drug costs
Integration of drug cost savings opportunities
To learn more about drug spending, check out our site Pharma Life Sciences.
To watch video clips from AHIP 24, subscribe to our YouTube channel, @HealthcareStrategies.

Industry Perspectives: Exploring the latest in behavioral health innovation

Since the coronavirus pandemic, mental and behavioral health awareness has improved and innovation in this area has exploded. What is the industry up to now?
Guest: Solome Tibebu, Founder and CEO of Behavioral Health Tech
In today's episode, we'll cover
Behavioral healthcare technologies
Challenges and progress in behavioral health since the coronavirus pandemic started
One key message to payers about behavioral healthcare technology
To learn more about behavioral healthcare technologies, check out our site Virtual Healthcare.
To watch video clips from AHIP 24, subscribe to our YouTube channel, @HealthcareStrategies.
 

Industry Perspectives: Scaling Interoperability Efforts

The next big thing in interoperability may involve scaling data exchange efforts.
Guest: Terry Douglas, Product Marketing and Sales Enablement Director at Surescripts
In today's episode, we'll cover
The role of QHINs in interoperability's progress
Areas for improvement in payers' data exchange efforts
Opportunities for innovation in payers' interoperability strategies
To learn more about interoperability, check out our site Health IT and EHR. 
To watch video clips from AHIP 24, subscribe to our YouTube channel, @HealthcareStrategies.
 

Industry Perspectives: What quality measures mean to Medicare Advantage

Quality measures play an important role in the Medicare Advantage program. SCAN Health Plan's recent lawsuit against CMS revealed just how important.
Guest: Sachin Jain, MD, CEO of SCAN Health Plan
In today's episode, we'll cover
SCAN Health Plan's lawsuit against CMS
Improving the Medicare Advantage program and Medicare Advantage quality measures
Getting over toxic positivity in the health insurance industry
To learn more about Medicare Advantage, check out HealthPayerIntelligence.com
To watch video clips from AHIP 24, subscribe to our YouTube channel, @HealthcareStrategies.
 

Industry Perspectives: Tracking employer sponsored health plan trends

Employer sponsored health plans cover six in ten non-elderly Americans, making successful collaboration between payers and employers crucial to many Americans' wellness. Todd Woodruff, Chief People Officer at Salt & Straw, and Todd Burton, President of the Commercial Market at Providence Health Plan, shared about trends in mental health, pharmacy spend, and health equity in the employer-sponsored health insurance space.

Industry Perspectives: Standardizing provider data for health plans

Providers are expected to equip payers with information so that health plan members can find in-network care. But what if those demands from payers were consolidated from 20 separate requests into one? What if providers could enter their information one time in such a way that all of their payer partners could access it? Tyler Ford, Vice President, Strategy and Partnerships, CAQH, shares how that might be possible in today's episode.

Industry Perspectives: Charles DeShazer, MD, Chief QHA Officer at Cigna

The generative AI revolution is here. How should payers respond and how can they learn from past technological revolutions in healthcare to inform their next steps? Charles DeShazer, MD, Chief Quality and Health Advocacy Officer at Cigna Healthcare, offers his recommendations in this episode of Industry Perspectives.

Driving SDOH data standardization for health equity

In this last episode of season 5 of Healthcare Strategies...
The United States has a health equity problem, but a lack of comprehensive data standards has limited efforts to mitigate health disparities. In this episode, Keysha Brooks-Coley, vice president of advocacy at Blue Cross Blue Shield Association (BCBSA), discusses the importance of standardized SDOH data in pursuing health equity.
Don't worry, we'll be back in September with more great conversations! In the meantime, tune in to our Healthcare Strategies | Industry Perspectives every Thursday for insights from AHIP 2024. Subscribe to get the episodes when they drop!