Author: Vedant Bhosale

Industry Challenge According to the recent Gartner report on “How Clinical Data Improves US Healthcare Payer Interoperability,” health plan leaders are counting on the integration of clinical data “locked in provider’s electronic health records” to enable a host of needed…

Artificial intelligence (AI) has dominated conversations among health plans and providers because of its potential to transform the industry. From predictive models for disease onset to chatbots answering member questions, the number of potential AI applications are innumerable. Yet, not…

Our country is facing a national mental health crisis. About half of the U.S. population will experience a major mental health issue during their lifetime, and approximately 20% of the population has a diagnosable mental health condition in any given…

Kindred Hospitals, a national network of long-term acute care hospitals (LTACHs), provide specialized treatment and rehabilitation for medically complex patients. LTACHs like Kindred are equipped to provide the same level of treatment as short-term acute care hospitals (STACHs) can but…

Executive Summary: Health plans must ensure network adequacy to meet regulatory requirements, maintain consumer trust, and provide a fulfilling member experience. However, network adequacy remains a fundamental challenge for plans due to inaccuracies in provider data. Health plans struggle with…

For health plans, the numbers are sobering: rising medical loss ratios, escalating healthcare costs, and increasingly complex patient needs are straining resources across the industry. Yet within this challenging landscape lies an overlooked opportunity for transformation: medication optimization.

The Future Must Be Less Wasteful, More Collaborative Misaligned policies, medical necessity screening tools, and incomplete clinical data are chief contributors to rising claims denial rates. They’re a challenge that costs hospitals and health systems nearly $20 billion per year,…

Healthcare payer marketers are caught between a rock and a hard place: They are responsible for driving growth for their organizations, yet are hamstrung by their legal and compliance colleagues in terms of the digital strategies they can deploy to…

The tools you rely on for effective digital advertising could disappear tomorrow. That’s not hyperbole, or a scare tactic. It’s already happening to healthcare providers right now. As trust in payers erodes and scrutiny around privacy intensifies, it’s only a…

In an interactive session at Becker's Fall Payer Issues Roundtable, Sri Palanisamy, Principal at ZS, led a discussion on unique opportunities and challenges of provider partnerships, particularly for Blue Cross Blue Shield (BCBS) plans. The panel included Jason Hover, vice…