Author: Vedant Bhosale

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…

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…

Discharge decisions may contribute to the significant healthcare challenges associated with sepsis. Though sepsis patients are often discharged to skilled nursing facilities (SNFs), data demonstrates that transitioning patients to long-term acute care hospitals (LTACHs), which provide continued acute care for…

In traditional claim processing, the lack of interoperability between health plan and provider systems often leads to challenges and inefficiencies, like manual data exchange and a lack of transparency. This results in claim denials that drive unnecessary administrative work and…

Executive Summary Payer-provider contracts are the backbone of financial and operational efficiency in the U.S. healthcare ecosystem. Seemingly straightforward, a payer-provider contract is the legal agreement between a healthcare payer and a provider that outlines the terms for delivering and…

With recent breakthroughs in artificial intelligence (AI), health plans are at a precipice of change. At Optum, we’re leveraging emerging technologies to drive payment accuracy—but it’s just the starting point. We believe AI has the potential to completely transform the…