In today's healthcare landscape, where nearly half of the US population is dealing with multiple chronic conditions, an effective chronic care management (CCM) system is essential. An effective solution aims to improve patient outcomes, enhance quality of life, and reduce the burden on the healthcare system's resources.

NCQA quality measures evaluate health plans on their effectiveness, patient experience, access to care, and care coordination. These measures ensure that healthcare payers deliver high-quality care, leading to better health outcomes for enrolled individuals.

Sara: The Next Frontier in AI for Healthcare

Happy holidays innovators!

I love Moneyball. It’s a great book, a gripping movie, and a powerful concept about how to ask the right questions about value, when everyone else is asking the wrong ones. Though I’m in healthcare and I never played baseball growing up, I’m passionate about data and the kind of analysis that Moneyball illustrates.

According to CMS, 7 out of 10 hospitals participating in the Hospital Readmission Reduction Program (HRRP) will face penalties in 2024. Around 70% of hospitals will incur penalties of less than 1% for their readmissions, while 7% will face penalties of 1% or more. This poses a significant challenge to the healthcare industry's pursuit of value since readmissions are one of the biggest costs hospitals must bear.

Indiana-based multi-specialty physician network is using the Innovaccer platform to reduce readmissions, automate ED transition workflows, and improve the patient experience to provide convenient and comprehensive care

The long journey toward healthcare data interoperability is occasionally punctuated by a new CMS regulation that catches everyone’s attention and triggers some degree of urgency or course correction. Most recently, that “shot across the bow” has come in the form of CMS’s new eCQM (electronic clinical quality measures) requirements. The proposed regulations will require ACOs to aggregate and electronically report clinical quality data—a prospect that has created consternation in the ACO community. 

Risk adjustment programs play a fundamental role in correctly assessing and documenting a patient's health. These programs predict service needs and craft effective care models, which result in the cost-effective improvement of health outcomes.

Past innovations in IT might pale in comparison to the global impact of AI—but only if vertical industries—like healthcare—define and deliver on the jobs to be done