Category Archives: Government

Addressing social determinants of health can improve overall health outcomes

John Selig, senior vice president at the Lewin Group and former director of the Arkansas Department of Human Services, was interviewed recently at the Health IT Summit hosted in Baltimore (April 5–6). He discussed the impact of social determinants of health (SDOH) on overall health outcomes. SDOH is still a relatively new area of focus […]
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Artificial intelligence unlocks buried data

Did you know that more than half of the information contained in electronic medical records is unusable to health care organizations? Mark Morsch, Optum360 Vice President of Technology, says studies show 60 to 80 percent of EMR content is unstructured. That means some data that could potentially be used to create a more complete picture […]
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Learn to speak the same health care language

Take a trip around the world and you’ll hear a lot of different languages, including some you probably won’t understand without a translator. Data is the language of today’s health care system. But a patient’s journey through that system collects data from a variety of sources in many different formats. It’s hard for anyone to […]
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The cure for analysis paralysis

A whole week devoted to health IT and how it’s transforming the world? Now that’s what I’m talking about! Las Vegas is home to this year’s HIMSS conference. (Shout out to our crew in Booth 6425 — stop by for a coffee if you’re in town! Our folks would love to talk shop with you.) […]
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How raw data becomes real health care insight

Technological progress is astounding. Smartphones have made it easy to get the answer to almost any question: What’s the weather today? What was the score of the Super Bowl? Yet in health care, technology sometimes makes things complicated. Ever-evolving collection methods have created mountains’ worth of available data. While such advances have allowed payers, providers […]
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Vermont cites improved health exchange, Optum contribution

Vermont is publicly touting the improvements in its health insurance exchange, Vermont Health Connect (VHC), and has cited work by Optum, VHC’s systems integrator, as a big reason for their success. Administration officials recently delivered their final monthly report on VHC to the state legislature, a largely positive document that listed numerous improvements and successes […]
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Calculating the incalculable

We often hear from state program integrity units that the work they do goes unrecognized. Yet when quizzed on how they promote their efforts — which could result in millions of dollars in savings and recoveries over just one year — they often reveal a limited understanding of how to calculate these savings. After all, […]
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Maintaining your provider network: Tips for keeping docs despite an audit

As a Medicaid agency, you’re tasked with maintaining a provider network of sufficient size, quality, geographic range and breadth of services to meet the needs of your state’s most vulnerable population. But maintaining positive, productive provider relations during a recovery audit can be challenging. One thing you can do is build up a store of […]
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Getting behind the science: Program integrity, predictive analytics and best practices

Whether you pluck the petals from a daisy or gaze into a crystal ball, the traditional means of predicting and influencing future events has always carried a high degree of risk. Fortunately, when it comes to analyzing claims data, there are proven methodologies —predictive analytics — that states can use to help assess the validity […]
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10 tips for working with MCOs to advance Medicaid program integrity

Have you turned to managed care organizations (MCOs) to reduce Medicaid costs and improve patient care? If so, you probably know how difficult it is to know for sure whether your MCOs are doing all they can to reduce fraud, waste and abuse. In May 2015, CMS proposed a new rule that MCOs strengthen their […]
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