claims data

Top waste, fraud, and abuse red flags, and how to identify them: In some cases of healthcare fraud, it’s easy to spot red flags. But in large healthcare organizations, or on the payer end, fraud and waste can be more difficult to detect through layers and layers of data.
Prescribing practices that increase risk of opioid overdoseTwo studies, one from Prime Therapeutics and Stanford, reveal an alarming increase in overdose with concurrent use of opioids and benzodiazepines. Here’s how managed care can help.
Remote Patient Monitoring is a Wise Investment for PayersThe results of Geneia’s year-long study – a savings of $8,375 per patient and a slowing of disease progression – demonstrate that remote patient monitoring is a wise investment for payers.
Advanced Analytics Improve Physician Engagement and Performance in ACOsHealth plans are using advanced analytics to improve physician engagement, performance and satisfaction in ACOs and risk-sharing contracts.
Payers Can Help with the Joy of MedicinePayers have a direct interest in preserving independent physician practices and helping all physicians regain the Joy of Medicine.
Advanced Analytics Triple Win for PayersThe use of advanced analytics by payers can improve administrative and medical costs, provider satisfaction and member health.
CMS updates data mining rule to enrich patient careCMS finalized new rules that aim to enrich the Qualified Entity Program by expanding access to analyses and data that will help providers, employers, and others make more informed decisions about care delivery and quality improvement.
How analytics can help navigate the great data divideNow that the ACA has eliminated pre-existing conditions, payers have taken on many unknowns when evaluating the massive population of new members coming in from the state and federal exchanges.
5 population health technology tipsHow to collect, compile and present data
5 ways to use big dataChoose your goals before crunching numbers