Today, nearly half of Americans struggle to afford basic healthcare, and patients wait an average of 38 days to see a doctor. At the same time, 80% of at-risk members remain unreachable. These barriers are unsustainable for members and health plans alike. While value-based care…
Author: Vedant Bhosale
For all the progress made in shifting the U.S. healthcare system toward value-based care, one of the most powerful levers for improving outcomes and reducing costs remains underused: medications. Medications influence every dimension of health outcomes. They prevent disease progression,…
Today’s durable medical equipment (DME) process can be fragmented, inefficient and unreliable, leading to delays, errors, and rising costs. At Optum, we’re rethinking what’s possible with a transformative, digital, end-to-end experience that enhances efficiency, transparency, and reliability. Read more to…
The Medicare Advantage (MA) market is entering a potentially transformative phase. Profit pressures, regulatory shifts, and an evolving reimbursement landscape are converging to prompt a strategic reset. A shift from growth-at-any-cost to profitability-first Like many publicly traded payors with significant…
Improving member experience remains a top priority for payers — and for Medicare Advantage plans, it’s not just a goal but a business imperative. Member experience directly influences CMS Star Ratings, which in turn affect financial performance. At the heart…
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Today, the durable medical equipment management (DME) process can be fragmented, inefficient, and unreliable – leading to errors and delays that impact member health, inflate costs for health plans, and burden clinicians with administrative complexity. But what if the end-to-end…
While best known for our healthcare technology, InterSystems is a global leader in interoperability across multiple industries. One goal common to all of them is achieving the level data liquidity needed to unlock simultaneous breakthroughs in quality and efficiency. However,…
When a critical patient’s prognosis is unclear, often because they are unable to wean from the ventilator, care teams begin to discuss palliative care, advance care planning, and even hospice. Making decisions about long-term care goals can be challenging for…
It was Tuesday at 3pm, and Michael, a health plan compliance officer, paced around his office in frustration. A new state law mandated a fundamental change in reporting data related to claims reimbursement policies. The deadline was looming, and his…
Traditional claim processing is plagued by interoperability issues, leading to manual data exchange and lack of transparency. Real-time, automated data exchange between health plans and providers can help. By sharing eligibility, claim and payment data upfront, providers can identify and…