Although end-to-end digital claims management is still a distant vision, much can be gained from digitizing portions of the claims process today.
Topic Healthcare analytics
Smart hospitals make extensive use of innovative technologies to improve care quality and patient experience while reducing costs.
Hospital care is changing both rapidly and radically. Because of innovations in care delivery and organisational structures, future hospitals are likely to be very different from those of today.
Technology-driven innovation holds the potential to improve our understanding of patients, enable the delivery of more convenient, individualized care—and create $350 billion–$410 billion in annual value by 2025.
Artificial intelligence (AI) is increasingly being adopted across the healthcare industry, and some of the most exciting AI applications leverage natural language processing (NLP). Simply put, NLP is a specialized branch of AI focused on the interpretation and manipulation of human-generated spoken or written data. In this infographic, we describe a few promising NLP use cases for healthcare payers and providers. We elaborate several specific approaches and their associated applications. Finally, we lay out a case study describing how we have used NLP to accelerate benchmarking clinical guidelines.
Society is aging and healthcare costs keep rising. By digitizing the system, health services can be provided at lower cost and higher quality. A new study reveals the areas for and extent of potential improvements.
Although the opioid crisis in the US is gaining increased attention, the steps taken to date to combat it are insufficient. Our research suggests that much broader—and bolder—action is required.
Machine learning is transforming the healthcare industry by changing the way care is delivered, and its impact is poised to increase.
Careful analysis of health insurers’ claims data can provide important insights into the opioid crisis by identifying patterns that could help shape strategies to combat opioid dependence and abuse.
Radiology is essential to patient care, but where there's variation in spend, there's potential opportunity for payers to decrease costs.
Extending the use of episode analytics beyond alternative payment models: A scalable architecture for improving payer performance
Payers (and providers) that have dismissed bundled payments or treated it as a narrow part of their strategies may under-appreciate the value of episode analytics in improving core business functions.
Low back pain is common and costly. By providing a longitudinal view of treatment patterns, patient journey analytics can identify opportunities for timely, high-quality, cost-effective interventions.
As more data about individuals with special care needs becomes available, the latest innovations in data analytics can be used to transform care delivery for them in a financially sustainable way.
At health insurers, artificial intelligence can strengthen claims management by systematically identifying and correcting errors while avoiding ineffective interventions.
In this interview, Otto Bitterli (Chairman of Sanitas Health Insurance) discusses the company’s digital transformation and its commitment to being an innovative long-term partner to its customers.
An analysis of the individual market health plans being offered across the U.S.reveals that the trends toward narrowed hospital networks and managed care continue.
Analysis of exchange premiums indicates that overall prices will continue to increase in 2017. Despite this, some consumers will see their premiums decline given the effect of government subsidies.
Analysis of exchange plans indicates that a majority of carriers are continuing to shift toward managed offerings, and consumers will see less unmanaged plan designs available to them than in previous years.
Analysis of exchange carrier participation nationwide indicates that the overall number of carriers has dropped below 2014 levels. However, a majority of markets will continue to have more than one carrier participating.
Traditional arguments for EHR implementation such as efficiency gains and meaningful-use incentives are insufficient to maximize a health system’s returns on its technology investments. However, clinically and operationally oriented sources of value can generate an additional $10,000 to $20,000 per bed in annual margin.
While the individual market is still in flux, careful analysis of carriers’ performance reveals several factors are associated with better results.
2014 performance in the individual market varied among payors – most had negative margins, but ~30% of carriers' margins were positive.
Based on nationwide 2016 individual exchange rates, here are overall and state-by-state insights on carrier participation, price leadership shifts, gross premium changes, and the impact of subsidies on 2016 rates.
Between 2013 and 2014 absolute enrollment and revenue grew by 17 million lives and $86 billion respectively.
Despite higher increases in lowest-price plan gross premiums this year, a greater share of consumers are seeing less expensive lowest-price silver net premiums.
The mix of carriers and plans is continuing to change, with nearly half of consumers seeing a new entrant, and plan types becoming more managed.
Updated 2015 network data, including a comparison of networks offered on the 2014 and 2015 exchanges, insights into how networks’ pricing structures are evolving, and insurer and provider participation.
Observations based on analysis of Medicaid/CHIP enrollment estimates through December 2014.
State-by-state data and analysis on approved 2015 products offered on federal and state Individual exchanges
Survey findings shed light on how a variety of factors could affect the decisions consumers make about enrolling: eligibility for subsidies, penalties for not enrolling, satisfaction with 2014 plans, and increases in premium rates.
A close look at the public exchange network in 2014.
With the first OEP concluded, this retrospective overview shows how the market landscape has evolved.
This updated view of the network configurations being offered on public exchanges across the country suggests that consumer choice of health plan design is expanding.
Our fourth intelligence brief on exchange dynamics shares observations of the individual market through the mid-point of open enrollment.
Our third intelligence brief on ACA exchange dynamics sets forth five observations based on analysis of new network configurations across 20 urban rating areas.
Our second brief on exchange dynamics is based on a comprehensive analysis of all exchange offerings across the entire US—more than 21,000 unique qualified health plans filed on the public exchanges in all rating areas.
This brief comprises an initial set of analyses regarding the structure, competitive dynamics, and pricing on the exchanges, and their implications.
The trillion-dollar prize: Using outcomes-based payment to address the US healthcare financing crisis
There is growing consensus that transitioning to outcomes-based payment is fundamental to driving cost-reducing innovation among healthcare providers and achieving a financially sustainable healthcare system.