Category Archives: Payer

Unlocking insights and value within health care data through NLP

I recently called natural language processing (NLP) artificial intelligence (AI) with an ROI — and yes, it’s a catchy phrase, but it’s also true. NLP is an essential asset in today’s health care landscape. Let me tell you a story. Bill and Ted work at the same company – Excellent Adventures, Ltd. – but they […]
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Osler Health’s journey to greater analytic sophistication

With health care providers treating hundreds of thousands of people each year, the amount of data generated by those interactions is complex and overwhelming. Yet it is this very data that answers the questions central to health care management and achieving the Triple Aim. The challenge for health care providers is to develop strategies that […]
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HfS Winner’s Circle Recognition for Optum Health Care Business Operations Services

An interview with Brian Murray, Senior Vice President, Optum HfS Research is a global research and advisory firm. They recently published their Healthcare Business Operations Services Blueprint. It provides an analysis of the business process services and outsourcing market for health care business operations. HfS placed Optum in the HfS Winner’s Circle for its data- […]
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The 10 most significant HEDIS challenges

Improving quality measures and HealthCare Effectiveness Data and Information Set (HEDIS®) scores is becoming increasingly important to improving Star ratings and bottom-line performance. But to boost HEDIS scores and gain competitive advantage, health plans must be aware of the challenges and the strategies necessary to meet them. The 10 most significant HEDIS challenges and strategies: […]
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AHIP Institute & Expo focuses on complex priorities for payers

What are the biggest disruptors to our health system, and what is their potential impact on your future business strategies? How can improved infrastructure and technology benefit clinical care, increase efficiencies and reduce costs? How do we build long-term relationships with consumers? These questions and more will be addressed during the AHIP Institute & Expo, […]
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CMS Advance Notice and 2017 Draft Call Letter: Implications for MA and PDP plans

The Centers for Medicare & Medicaid Services (CMS) released its 2017 Advance Notice and Draft Call Letter in February, proposing numerous changes for Medicare Advantage (MA) and Part D plan sponsors. The notice contains both opportunities and challenges that you will need to assess in order to determine how your organization will react. It’s important […]
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Oncology issues and solutions: Establishing a comprehensive care strategy

While cancer continues to be one of the most common causes of death in the United States — exceeded only by heart disease — there is some good news. Prevention and early detection/treatment are improving five-year survival rates, with clinical care and treatment options advancing as more is understood about the disease. Complex care, complex […]
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Preparing your business for technology change: Nine essential readiness activities

In last week’s blog, we discussed the benefits and risks associated with major technology change. This week we offer perspective on the nine essential readiness activities that will help you prepare for major technology change. It’s important to realize that these nine activities: Do not need to be performed in order Are mutually exclusive Can […]
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Readiness activities to prepare your business for technology change

Across the health care industry, payers are asking themselves if their technology platform is ready for the future. There are two avenues to explore where technology change is concerned – either upgrade your existing system or completely overhaul it. The drivers behind technology change can determine the extent to which change needs to happen. Complex […]
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