29 Apr Health Data News Roundup: ONC Releases TEFCA Common Agreement Version 2.0; Major Health Insurance Companies Too Big to Fail; and AI and Claims Processing

Welcome to the Health Data Weekly News Roundup from IMAT Solutions. As the power of data continues to grow in the healthcare arena, today’s care organizations need to be on the forefront of all news and trends to help ensure that their data analytics efforts deliver accountable and informed care. Each week, we will provide you with the actionable news you need to meet these goals.

ONC Releases Common Agreement Version 2.0 for TEFCA
ONC and its Recognized Coordinating Entity (RCE), The Sequoia Project, have released the TEFCA Common Agreement Version 2.0 (CA v2.0), which includes new requirements for FHIR API exchange.

UnitedHealth Says Hackers Possibly Stole Large Number of Americans’ Data
Last week, UnitedHealth Group said that hackers stole health and personal data of potentially a “substantial proportion” of Americans from its systems in February, as the largest U.S. health insurer works to contain the damage.

Provider Markups on Specialty Drugs Increased Commercial Premiums
Provider markups on specialty drugs increased 2024 commercial health insurance premiums by $13.1 billion, according to research from Oliver Wyman commissioned by AHIP.

Can AI Manage High-Cost Claims? Not Without Humans
AI, combined with human expertise, can play crucial roles in managing the growing complexity and volume of high-cost healthcare claims, according to this recent Health IT Analytics article.

Elevance Health Launches Specialty Pharmacy Navigator
CarelonRx, Elevance Health’s pharmaceutical services arm, will launch SpecialtyRx Savings Navigator, which will provide employers with disease-specific forecasts to help them predict future spending on pharmacy and recommendations for plan design.

Major Health Insurance Companies Are Nearing Too Big to Fail Status
Health insurance companies have swelled in both size and scope over the last decade, with the revenues of six for-profit parent companies making up nearly 30% of total U.S. health spending last year — compared with less than 10% in 2011, according to this Axios article.

LTC ACO Welcomes New Chief Operating Officer
LTC ACO, the first Accountable Care Organization (ACO) in the U.S. exclusively dedicated to long-term care facility residents, last week announced that Michele Fronckiewicz has been named chief operating officer.