risk adjustment Tag

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11 Jun Why Health Plans Are Shifting Focus from Data Exchange to Data Intelligence

Posted at 09:34h in Health Payers by Matt Langan 0 Comments
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Top Takeaways • Health plans are increasingly focused on maximizing the value of existing health IT investments. • Interoperability remains important, but organizations now need data that is trusted, usable, and actionable. • Health plans are moving from experimentation to operationalization as AI becomes embedded into workflows such as risk adjustment, claims, and utilization management. • Provider data quality challenges continue to impact operational efficiency, member experience, and reporting accuracy. • Quality, Stars, HEDIS, CAHPS, risk adjustment, and care management...

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03 Jun Why Health Plan Data Infrastructure Is Becoming a Competitive Advantage

Posted at 09:30h in Health Payers by Matt Langan 0 Comments
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Top Takeaways • Health plan leaders increasingly view actionable data as a strategic asset for improving affordability, operational efficiency, and member outcomes. • AI adoption is accelerating across payer organizations, but success depends on trusted, normalized, and auditable healthcare data. • Health plans are moving from experimentation to operationalization as AI becomes embedded into workflows such as risk adjustment, claims, and utilization management. • Data quality and interoperability remain foundational challenges that must be addressed before organizations can fully...

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26 May Health Data News Roundup: Healthcare AI Needs Quality Data; MA Transparency Overhaul; and C3HIE Live on TEFCA

Posted at 08:25h in Health Data News Roundup by Matt Langan 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. Why Quality Data is Key to Healthcare AI Fulfilling Its...

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22 May Medicare Advantage Compliance Is Entering a New Phase. Health Plans Need Better Data Foundations.

Posted at 05:13h in Medicare Advantage by Matt Langan 0 Comments
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Top Takeaways • Medicare Advantage oversight is intensifying as CMS and federal regulators place greater scrutiny on audit readiness, risk adjustment accuracy, and data integrity. • Risk adjusted data validation is becoming more critical as plans prepare for increasing compliance expectations and operational complexity.• Fragmented data environments create compliance risk when clinical, claims, and encounter data cannot be trusted or validated consistently.• Audit ready data infrastructure is becoming essential as health plans face growing pressure to support...

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