Data Mining

March 28, 2014 | Karen Appold

As the Affordable Care Act continues to disrupt the health insurance industry, health plans must broaden their definition of risk as they calculate rates and attempt to better understand their members' needs.

March 27, 2014 | Kurt Ullman

The relationship between payers and providers has often been adversarial, but healthcare reform has been changing that, leaving former adversaries trying to figure out how to create new partnerships.

March 4, 2014 | Anthony Brino

The Centers for Medicare & Medicaid Services has a lot of data on Medicare Advantage plans that it should be using to inform policy and make available to the public, according to a new Inspector General report.

February 13, 2014 | Mike Miliard

Optum Labs, the research center founded by UnitedHealth and Mayo Clinic, has added seven new health organizations, which will join in on data mining research to find innovative ways to improve quality and reduce costs.

January 21, 2014 | Mike Miliard

As they try to get a better handle on population health management and member engagement, payers are increasingly looking to consumer-facing technologies for help, according to the latest report from Chilmark Research.

October 21, 2013 | Mary Mosquera

WellPoint is taking a tough stance to try to combat prescription drug abuse and fraud activities that bubble to the surface through predictive analytics and other data runs of its members and their providers and pharmacies.

October 16, 2013 | Mary Mosquera

Blue Cross Blue Shield of Michigan has launched an initiative using claims data to help hospitals across the state better understand their practice patterns compared with their peers, in an effort to improve patient outcomes and manage costs.

October 3, 2013 | Mary Mosquera

S&P Dow Jones Indices has launched a new indicator that measures claims data from 33 leading health insurance companies and other organizations to calculate the growth in commercial healthcare costs.

September 4, 2013 | Bernie Monegain

Carolinas HealthCare System is one of the first health systems without a provider-sponsored health plan that will integrate payer and provider data to improve the health of people across the Southeast.

July 29, 2013 | Mike Miliard

UPMC has invested more than $1.6 billion in its IT infrastructure over the past five years, according to Pamela Peele, chief analytics officer of UPMC Health Plan. That's more money, she points out, than its home city has spent on three pro sports stadiums combined – "and we take sports seriously in Pittsburgh."

July 1, 2013 | Mary Mosquera

Insurer Highmark and its provider partner Allegheny Health Network will invest $11 million in the creation of the Disruptive Health Technology Institute at Carnegie Mellon University, in a collaboration to come up with breakthroughs to make health care more affordable, simplified and accessible.

June 7, 2013 | Mary Mosquera

As convergence around the needs of patients and consumers intensifies, payers, providers, and employers are collaborating beyond their traditional boundaries. IBM's Institute for Business Value and the AHIP Foundation's Institute for Health Systems Solutions recently conducted research on this issue and its implications and will release their findings at this week's 2013 AHIP Institute.

March 25, 2014 | White Papers
Internal subrogation units can generate significantly more recovery dollars than those earned by using an external firm. This white paper outlines the steps to take to establish a well-run unit and find the right case management technology.

March 11, 2014 | White Papers
For health insurers, data integrity and visibility are key to successful integration with the Federal Marketplace. However, complex processes and trivial errors can lead to data gaps that impact revenue, profitability and member satisfaction. Adopting a standarized approach to data integrity early in the process is critical to succesfully adapting to the technologies and processes of the Affordable Care Act.

November 20, 2013 | White Papers
Whether they realize it or not, most healthcare payers are losing millions of dollars each year across activities such as COB, subrogation, eligibility, MSP validation, and more. Fortunately, a new generation of "intelligent" cost containment solutions helps cut the losses and achieve significantly improved recoveries, cost avoidance, and increased revenue - all of which support health reform priorities such as medical loss ratio and waste and abuse efforts. This white paper details real-world examples of "intelligent" cost containment success, best practices for improvement, and more.

October 9, 2013 | On Demand Webinars
The healthcare sector is going through massive transformation. Payers have to invest in readiness around data delivery to federal and state or multiple health insurance exchanges before Jan 1, 2014 deadline. While the ICD-10 adoption deadline has been pushed back due to industry pressures on regulator - it is still a huge undertaking for any healthcare entity that touches diagnostic or procedural codes. These are just some of the projects that are converging on healthcare IT teams this year. For healthcare CIOs and IT teams and especially application development teams this project overload translates into a cascading capital and operational cost burden. Learn how Presbyterian reduced storage, operational costs and realized significant productivity benefits around critical business processes.

October 9, 2013 | White Papers
Healthcare reform is transforming the US medical insurance sector - creating a dynamic and competitive new market with compelling opportunities for growth. But do you have the necessary responsiveness to capitalize on these opportunities? Here are the five compelling ways technology investment delivers agility you need - and how.

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