Missing diagnosis codes in standard risk algorithms can lead to inaccurate risk score calculations, impacting payment strategies and care plans. Our suspect code algorithm is designed to fill these gaps by identifying potential undocumented conditions based on clinical evidence such as lab results, procedures, medications, and anomalies in vitals.

Recognizing the crucial impact of Social Determinants of Health (SDoH) on pediatric care, the Accountable Care Organization (ACO) has implemented proactive interventions designed to enhance health outcomes for children. By focusing on SDoH needs, the ACO aims to create a more holistic approach to health care that addresses the underlying factors influencing the well-being of its patients.

Are You a State Medicaid Director, Healthcare Policy Maker, or IT Decision Maker?

The healthcare industry has long been ripe for disruption, and with the rise of MedTech innovation, transformation is finally starting to happen. Significant advances in digital technology and clinical solutions have driven the development of smart devices, companion applications, early diagnosis algorithms, and the delivery of better care to patients. Nevertheless, the associated explosion in data has exacerbated healthcare’s fragmented and siloed data ecosystems.

As many health systems are discovering too late, traditional CRM systems aren’t built to solve healthcare’s complex problems. They’re built to be sales-enabling tools that view the patient as a consumer transaction first and a “human on a care journey” second (if they view the consumer as a patient at all).

The pace at which value-based care (VBC) is growing could have a $1 trillion enterprise value, as per McKinsey.

In an outlandish episode titled “Spock’s Brain,” Star Trek’s Chief Medical Officer turned to a conversational AI called “Teacher” to help him perform a risky surgical procedure he’d never done before: transplanting Mr. Spock’s brain.

In 2021, CMS announced a goal to ensure that all traditional Medicare beneficiaries would have a provider who is responsible for both the quality and total cost of their care by 2030.

The changing landscape of healthcare, shaped by CMS (Centers for Medicare and Medicaid Services) and payers, emphasizes the economic aspect of medicine more and more.

Modularity, originally intended to aid states in breaking down monolithic technology systems, offers a solution to support agile policy evolutions. Modularity has been a dramatic success in many ways, shortening implementations, reducing vendor lock-in, and promoting innovation. However, complex procurement processes and lengthy implementations persist, preventing states from fully realizing the transformative potential of analytics.