The Millennium Alliance’s Post

In this Sg2 blog by Joe Maher, learn five emerging trends and dynamics in a subset of publicly traded legacy payers and #valuebasedcare focused entrants drawn from earnings call transcripts from 2023 Q3, including observations on: 💡 Strategic opportunities shifting from Medicare Advantage growth to member management 💡 The importance for health systems to develop or refresh their payer strategy https://bit.ly/49l3Jzp

If you’re struggling with mounting claim denials, you’re not alone. The rising rate of denials is real – up 20% over the last 5 years, according to Healthcare Finance News – and is being exacerbated by payers using AI to make positive outcomes more elusive. The spike in claim denials puts a tangible financial and administrative strain on healthcare providers. A recent report by Premier, a healthcare purchasing and consulting organization, says hospitals and health systems spend an estimated $19.7 billion a year managing denied claims. To gain ground in the denials game that’s being played so effectively by payers, providers need to consider collaborating with an established RCM partner. Meduit’s experienced team leverages our own AI-powered technologies to preempt claim denials before they occur, increase response times, and accelerate cash flow. If you feel the squeeze of skyrocketing denials, regain control with Meduit’s RCM expertise and innovation. Learn more: https://hubs.li/Q02vtFYL0

Really interesting new use case we are seeing from MDisrupt clients. A new breed of founders and CEO's are emerging who want to talk to health system executives and payers BEFORE they build or as they consider their GTM and reimbursement strategies. We now offer this service for our clients to speak these experts for an hour or two as well as potentially including them on their advisory boards. We have health system executives from Kaiser, Providence, Atrium, Sutter, HCA and many more. Want to talk to payer execs? No problem, we have some incredible ones from Aetna, Blue Cross, Elevance, Optum a as well as Medicare/Medicaid.

Led by MDIC's Health Economics and Patient Value program, the Commercial Payer Council aims to streamline evidentiary requirements for coverage, expedite #patientaccess, and refine pathways for #coverage, coding, and payment—serving as a neutral platform for collaboration among diverse stakeholders. The Council's inaugural meeting covered pivotal topics like Medicare Advantage and #reimbursement for #digitalhealth technologies. As the healthcare industry continues to evolve, initiatives like the Commercial Payer Council play a vital role in shaping a more efficient, patient-centered #healthcare ecosystem, poised to meet the challenges and opportunities of the future. Learn more about this new MDIC initiative at https://lnkd.in/erMWYQ9V Key Insights from the Q1 meeting can be found at https://lnkd.in/ejRywsYP #healthcarecoverage #healthinsurance #medtech #healthtechnology #medicaldevices #patientsafety #healthequity #obesity #FDAapproval #healtheconomics #patientfirst

Risant Health recently purchased Geisinger in PA. Geisinger is primarily a value-based care provider, but also has ~100,000 Medicare Advantage members. Most of which look to be in the more "rural" areas of PA. For more info on the acquisition see the article linked in the first comment below. It sounds like Risant is interested in purchasing more value-based care providers. Will be interesting to see if those also include MA members. ___ Give me a follow. I post Medicare Market Insights daily!

It was an honor to lead Medical Device Innovation Consortium (MDIC)'s inaugural quarterly Commercial Payer Council, which highlighted how #healthtech companies can better navigate the commercial payer landscape, specifically Medicare Advantage and #reimbursement for #digitalhealth technologies. If you are with a #medicaldevice or #digitalhealth company in need of guidance on this topic, please read our Key Insights document which summarizes our discussion and provides key considerations. #medicareadvantage #medtech #digitaltherapeutics

The future of health will require coding, coverage, and payment that supports digitally enabled care. Discover the results of the AMA’s collaboration with Manatt Health, where we examined commercial payer coverage of #digitalhealth #CPT codes.

Join our webinar to learn how to maximize your leverage with payers at the negotiating table using cutting edge price transparency tools. #EllsworthConsulting #HealthcareInnovation #ConsultingServices #HealthcareLeadership #PayerNegotiations #HealthcareConsulting

Seeking to learn the latest strategies in obtaining better reimbursement results.

🔍 Addressing the Challenges of PBMs for Better Patient Access 🔍 In this insightful interview, Fred Barton, one of the driving forces at AffirmedRx, shares his expertise on the critical need for transparency in the pharmacy benefit management space. Fred breaks down the complexities of the industry, highlighting how PBMs can either contribute to rising healthcare costs or be part of the solution. At AffirmedRx, we're on a mission to reshape the industry by putting patients and employers first, offering full transparency and true accountability. Fred’s leadership and deep knowledge guide us as we work toward a future where PBMs are advocates, not gatekeepers. Learn more about how AffirmedRx and Fred Barton are leading the charge for healthcare reform and making pharmacy benefits clearer and more affordable for all. 💡 https://lnkd.in/ep5nhNSJ #PBMReform #HealthcareTransparency #FredBarton #AffirmedRx #PharmacyBenefits #PatientAccess #HealthcareInnovation