IMAT Solutions Blog

09 Mar Delivering Critical Health Data Infrastructure for Provider-Sponsored Health Plans

Posted at 21:24h in Health Payers by DesignWorks 0 Comments

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Rise of Value-Based Care Models Advancing Need for Better Financial Performance With today’s providers realizing that additional revenue streams are needed in the face of the rise of value-based care, many are considering launching their own Provider-Sponsored Health Plans (PSHP). PSHPs are health insurance companies owned by a health system, physicians group, or a hospital. The model encompasses the entirety of the continuum of care, from funding to care delivery, as well as connecting the payer and...

02 Mar How Health Payers Can Achieve True Digital Optimization in 2023

Posted at 19:11h in Health Payers by DesignWorks 0 Comments

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Healthcare payers must continually evolve digital capabilities in line with ever-changing business requirements, which can be achieved through continual IT optimization strategies. .ytvideo { aspect-ratio: 16 / 9; width: 100%; } While many payers are beginning to make strides in implementing digital-first member services, many are challenged with compliance hurdles, economic uncertainty and expanded expectations for enhancing overall member care. These are the key highlights of Gartner’s “Healthcare and Life Science Digital Optimization and Modernization Primer for...

22 Feb Helping Health Payers to Reimagine How They Do Business

Posted at 09:00h in Health Payers by DesignWorks 0 Comments

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As with any industry sector these days, the U.S. health payer arena faces some significant challenges from unlikely players. For example, technology giant Amazon, CVS Health, Walgreens, and other retailers are becoming healthcare industry staples, and a significant competitive threat. In fact, in an effort to eliminate administrative complexities in healthcare, Amazon aims to be the first claims-free payer by 2026. In addition, many payers still rely on cumbersome legacy processes in the face of rising regulatory...

08 Feb How Clinical Health Data Can Help Life Insurance Providers

Posted at 19:21h in Health Payers by DesignWorks 0 Comments

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In the life insurance sector, actuaries play a critical role in leveraging statistical analysis for developing annuity and life insurance policies for individuals and groups. This involves analyzing and estimating how long someone is expected to live, based on a wide-range of factors – with the goal of minimizing the risk for the life insurance provider. When it comes to analyzing the health of a potential new policyholder, life insurance actuaries typically leveraged data from health...

06 Feb Health Data News Roundup: Medicare Advantage Audit Ruling; Lack of Encounter Data for MA Supplemental Benefits; and Cigna Reduced Care Costs

Posted at 09:00h in Health Payers by DesignWorks 0 Comments

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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. New Medicare Rule Aims to Take Back $4.7 Billion...

02 Feb How to Overcome Health Data Quality and Interoperability Challenges

Posted at 18:51h in Health Payers, HIEs, Hospitals and Clinics by DesignWorks 0 Comments

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IMAT DaaS Solution Provides Access to Clean and Validated Data, While Enhancing Interoperability Capabilities A recent study from Health Gorilla found that poor data quality and information sharing remain a challenge to the vast majority of healthcare systems. More than 130 executive decision-makers across the healthcare ecosystem reported that 60 percent of healthcare systems had duplicative or incomplete data retrieved through health information exchanges. Sixty nine percent of digital health executives also reported gaps in their...

19 Jan Clinical Data Integration Benefits for Healthcare Payer CIOs

Posted at 18:54h in Health Payers by DesignWorks 0 Comments

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In today’s competitive business climate, U.S. healthcare payer CIOs want to deliver quick wins for business leaders with actionable insights from a broad range of structured/unstructured and nonstandard clinical data. Therefore, it’s critical to prioritize and implement Clinical Data Integration (CDI) capabilities by evaluating business objectives that take into consideration risk adjustment, quality measurement, and overall member management. Gartner estimates that more than 50 percent of payers will shift their CDI initiatives from projects to enterprise-based approaches...

16 Jan Health Data News Roundup: ONC Releases 2023 ISA Reference Edition; BCBSM and Full-Risk Value-Based Care Contracts; and Medicaid Social Determinants of Health

Posted at 09:00h in Health Payers by DesignWorks 0 Comments

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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 2023 Interoperability Standards Advisory Reference Edition ONC has...

13 Jan Using FHIR to Jump-Start Clinical Data Integration for U.S. Healthcare Payers

Posted at 17:03h in Health Payers by DesignWorks 0 Comments

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With the ONC and CMS interoperability mandates that are transforming clinical and administrative data exchange between payers, providers and patients, now’s the ideal time for payers to jump-start enterprise CDI investment to achieve compliance. As such, payers have the opportunity to embrace FHIR as the new common language for health data exchange, as well as tap into key vendors for bringing CDI initiatives to life. These were the key themes of the December 2022 refresh of the...

16 Dec Gartner: Customer Experience and Application Modernization Key Payer Priorities in 2023

Posted at 09:00h in Health Payers by DesignWorks 0 Comments

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Gartner recently released its “Top Priorities, Technologies and Challenges for Healthcare Payers in 2023” report (requires a Gartner subscription), which identifies enterprise priorities and tech spending trends for payers in 2023. While growth and technology modernization will be important priorities, enhancing the customer/user experience also topped the list. The report highlights how payers are pausing digital acceleration with a focus on tech optimization to maximize their technology investments. Gartner recommends aligning technology investments to specific goals and...