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Feb 5, 2021

Upgrading medicine through telehealth: true value for the dollar

Beginning in 2020, we have been seeing telehealth play a key role in providing care and filling access gaps for members/patients most at risk. The COVID-19 pandemic challenged the conventional health care models, as in-person office appointments became unfeasible due to strict social distancing guidelines and the need to reduce a patient’s risk of exposure. The expansion of telehealth enabled member/patients to experience continued care while reducing the risk of overburdening emergency departments and urgent care centers during the pandemic. Telehealth has presented a valuable alternative during these challenging times, with an added benefit of savings derived by reserving costly healthcare facilities and their resources for the people who need them most. According to America’s Health Insurance Plans (AHIP), telehealth could help save the United States as much as $4.28 billion on health care spending per year, and studies have shown net cost savings totaling $100 per visit.

Dec 10, 2020

Prescription discount programs: 4 must-haves for third party administrators

The cost of healthcare is going up for large employers and their employees by an estimated 5% for 2021. Even though plan sponsors continue to shoulder a generous 70% of the cost per employee, rising prices—particularly in the pharmacy segment—mean that the out-of-pocket spending burden for employees won’t get any easier to manage this year.

Nov 10, 2020

Besting disruption during critical events: A new option for health plans

Health plans are in the business of dealing with unexpected events while making sure members have safe access to medical and pharmacy care. However, even with comprehensive contingency planning, disruptions can still place a strain on staff and resources. Events outside the realm of “business-as-usual” can pile up for health plans, creating new challenges around maintaining daily operations amidst multiple, serious disruptions.

Oct 27, 2020

Paper EOI – Digitized, automated, adjudicated – BRIX + Vidado

Group insurance carriers are under enormous pressure—from competitors, customers and the C-suite—to improve medical underwriting outcomes by investing in ways to increase EOI submission rates, automatic adjudication, real-time decisions and a mobile-ready experience.

Oct 2, 2020

Operationalizing RPA for the healthcare industry using Business Process Management

Robotic process automation, or RPA, can be an effective way to reduce costs while improving the quality of repetitive tasks. Because there is so much opportunity, the RPA software market grew more than 63% between 2017 and 2018. However, an astonishing 50% of RPA implementation projects fail. What sets the successful projects apart? Business process management.

Sep 23, 2020

HEDIS® MY2020 Data Management – Expanding Use of Electronic Clinical Data Systems

In the final blog in this series, I want to touch on the evolution of using electronic clinical data in HEDIS measures. Data collection is one of the biggest challenges health plans face in preparation for HEDIS measures. The Electronic Clinical Data Systems (ECDS) framework was designed to increase the efficiency of quality reporting while also providing an incentive to connect to primary clinical information systems. Organizations that successfully report ECDS measures demonstrate interoperability of health data systems in the provision of high-quality care. NCQA’s commitment to the ECDS architecture was bolstered by the standards for interoperability finalized earlier this year.

Sep 16, 2020

SS&C Vidado’s AI-powered OCR wins 1st place in independent analysis

In their blog post Handwriting OCR Vendor Analysis, Cano AI compared SS&C Vidado’s AI-powered Optical Character Recognition (OCR) software against other top providers in the space.  Cano AI, a consulting group focused on discovering and sharing the most cutting-edge automation solutions, filled out a generic medical document containing a variety of short-form and long-form handwritten responses like the ones processed by healthcare and insurance companies. They then submitted this document to all three services and manually analyzed the accuracy rates.

Sep 10, 2020

Impacting HEDIS measures for COPD

Chronic Obstructive Pulmonary Disease (COPD) is a serious disease that places a heavy burden on affected patients and the healthcare system. Consequently, there are two Pharmacotherapy management measures related to COPD exacerbation for HEDIS Measurement Year 2020 (MY 2020).1 COPD is a group of lung conditions that include emphysema, chronic bronchitis and sometimes asthma. Symptoms of COPD include shortness of breath, cough and sputum production. Exposure to tobacco smoke or air pollutants usually damages the lungs and leads to COPD. Often, COPD patients develop breathing difficulties that become severely worse, known as exacerbations. Serious exacerbations can lead to hospitalization, decreased lung function and possibly death.

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