Author: Vedant Bhosale

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…

The Complex Wound Challenge Complex wounds represent a growing challenge to the healthcare community. As patients age and develop an increasing number of comorbidities, including diabetes and obesity, they are more prone to developing wounds and to experiencing longer, more complex…

Healthcare is constantly transforming, and payment integrity programs are facing unprecedented challenges fueled by rising medical spend, an evolving and unpredictable regulatory environment and increasing stakeholder expectations. These trends, coupled with a rapidly accelerating technology landscape, bring payment integrity to…

With healthcare constantly changing and health plans facing unprecedented challenges, payment integrity is at a critical inflection point. At Optum, we’re defining the future of payment integrity as payment precision—helping health plans achieve payment accuracy at claim submission. By advancing…

For years, health plans and provider organizations have been attempting to make value-based care work for them and their members. Yet for many, success has been elusive. Now, a new generation of technologies is helping advance value-based care by leveraging…

The business case for embracing electronic prior authorization, or ePA, nationwide seems overwhelming. Current prior authorization processes are a chief driver of provider and patient frustration. Needed investment in FHIR APIs is now mandated by CMS Rule 0057, and ePA…

During a featured session at Becker’s 3rd Annual Payer Issues Roundtable, Bob Tavernier, Sales Solutions Executive with Quest Analytics®, and Karen Tachian, Senior Director of Network Regulatory Operations with Health Care Service Corporation, unpacked recent survey data from 100 health…