Payment Models

The tool can help health systems optimize submissions and better predict potential issues with claims, the company says, giving recommendations to help mitigate denials before they're submitted.

A new study from the company explores the ways its algorithms can be put to work improving risk scoring and stratification and enhance value-based care initiatives.

Established firms have good track records, but there are high-performing developing companies, too; as providers tackled bigger strategic initiatives beyond mere EHR rollouts, they need to weigh how much they value experience and performance, a new report shows.

"We think every problem can be solved with machine learning," says one AI and analytics expert. "That’s not the case."

FCC Commissioner Brendan Carr has announced the agency will vote to advance a $100 million Connected Care Pilot Program, enabling telehealth expansion for low-income Americans nationwide. WHY IT MATTERS Speaking in rural Laurel Fork, Virginia, Carr announced that the new funding is meant to increase access to care to patients and veterans in remote areas such as Appalachia. “With advances in telemedicine, healthcare is no longer limited to the confines of traditional brick and mortar healthcare facilities,” said Carr in a statement. "I think the FCC should support this new trend towards connected care, which is the healthcare equivalent of moving from Blockbuster to Netflix. That’s why the FCC will vote to advance my $100 million pilot program at our July 10 meeting." He added that the program will "focus on ensuring that low-income Americans and veterans can access this technology, particularly in rural communities like Laurel Fork, where the nearest hospital is in a different state, access to telehealth can make a life-saving difference." FCC is set to vote on a notice of proposed rulemaking next month that will seek comment on several potential provisions, including $100 million in Universal Service Fund support that will help rural providers to defray the cost of offering remote care to low-income patients, including people in medically underserved areas and veterans. The NPRM would also seek support for new pilot projects to seek innovation diabetes management, the opioid crisis, high-risk pregnancies, pediatric heart disease and cancer, according to the FCC. It would also offer an 85 percent discount on qualifying services for three years, along with efforts to assess the benefits, costs and savings enabled by telehealth and remote monitoring tools. THE LARGER TREND Connected care technologies have already enabled cost efficiencies with the management of chronic conditions, the FCC points out. It estimates that more widespread use of remote patient monitoring and virtual visits could save the American healthcare system $305 billion each year. Moreover, it would enable better health outcomes. The agency noted a study of 20 RPM trials that found a 20 percent reduction in all-cause mortality and a 15 percent reduction in heart failure-related hospitalizations. Another initiative showed a 46 percent reduction in ER visits, a 53 percent decrease in inpatient admissions and a 25 percent shorter length of stay. As evidence of telehealth's benefits, the FCC pointed to a pilot project in the Mississippi Delta that resulted in nearly $700,000 in annual savings thanks to reduced readmissions. It also noted big ROI in a recent virtual care study in the Northeast, where every dollar spent on remote monitoring resulted in a $3.30 savings. ON THE RECORD But better health is the true value of telemedicine, and "in Laurel Fork, telehealth is already delivering results," said Carr from the Virginia press conference. "Diabetes patients here that participated in a remote telehealth program saw their A1C levels decline by 2.2 points on average, which significantly reduced their risk of renal disease, heart disease and death caused by those conditions. "Through the Connected Care Pilot Program, the FCC can build on the success of projects like these, which are helping create a model for the adoption of connected care technologies and bridging the doctor divide in rural America," he said. Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com Healthcare IT News is a publication of HIMSS Media.

A natural language processing algorithm has been helping the New York health system gain new insights from its unstructured notes, boosting its value-based care and pop health efforts.

Researchers at Case Western Reserve University are developing an analytics platform to help determine the medical necessity of using helicopters for emergency transport.

Payers are sizing up the ledger technology for payments and claims processing, but one big area of growth could be next-generation personal health records.

New API also integrates with Precision Medicine Sync for Science program, the vendor said. 

DOJ says court documents show Carolinas upcoded numerous tests, triggering higher payouts from government programs.