Sponsored by Zelis
How Human and Artificial Intelligence Can Streamline Claims Reviews
Amid the shifting landscape of medical claims, the rise of high-cost and complex claims has become a significant challenge for payers. Recent data from the Peterson Center on Healthcare and Kaiser...Humana Foundation Grants $1M to Address Food Insecurity, Mental Health
Humana’s philanthropic arm, the Humana Foundation, has awarded research grants totaling $1 million to three universities that will go toward improving food security and mental health in their...How Employers Can Promote Cardiovascular Care, Women’s Health
Cardiovascular, diabetes, and obesity treatments are a critical part of women’s health, and employers can take steps to ensure that women have access to information and care related to their...Payers Embrace Healthcare IT for Cost Optimization, Member Engagement
Payers are investing in healthcare IT resources to support cost optimization and improve member experience, according to a study from EY-Parthenon and KLAS Research. As payers face operational and...Sponsored by Zelis
Setting the Foundation for Member Engagement Across Populations
Member engagement has wide-ranging benefits, from improving health outcomes and controlling costs to ensuring consumer satisfaction, optimizing risk adjustment, and encouraging adherence to treatment...Medicare Hospice Model Improved Quality of Life, Reduced Medicare Spending
The Medicare Care Choices Model (MCCM) improved end-of-life care, increased hospice use, and reduced inpatient admissions for Medicare beneficiaries while simultaneously lowering Medicare spending, a...Blue Cross Blue Shield of MA Eliminates More Prior Authorizations
Blue Cross Blue Shield of Massachusetts (“Blue Cross”) joined other payers in eradicating prior authorizations for certain services as part of an effort to accelerate members’ access...Medicare ACO Enrollment Did Not Improve Mental Healthcare Outcomes
Medicare beneficiaries newly enrolled in accountable care organizations (ACOs) did not see any improvements in their depression and anxiety symptoms, suggesting Medicare ACOs may need better incentives...Preventive Care Visits Among Medicare Beneficiaries Grew, Study Finds
The share of primary care visits focused on preventive care nearly doubled between 2001 and 2019, with the steepest growth among Medicare beneficiaries, a Health Affairs study found. Periodic...Quality Outcomes Are Better When Medicaid MCOs Administer Pharmacy Benefits
Pharmacy-related quality outcomes were better in states where Medicaid managed care organizations administered health plans’ pharmacy benefits, according to a report from Elevance Health. The...Humana’s Value-Based Care Plans Improved Health Outcomes for MA Members
Humana Medicare Advantage beneficiaries receiving care under value-based arrangements had better health outcomes, including fewer inpatient admissions and emergency room visits, a report from the payer...Cardiovascular Disease Utilization Grew After Medicaid Expansion
Adults with cardiovascular disease are more likely to utilize outpatient cardiovascular services in Medicaid expansion states than in nonexpansion states, a study published in Health Affairs...How Much Members Spend on Diabetes Chronic Disease Management
Members with diabetes spend between $3,300 and $4,600 per year in out-of-pocket costs for chronic disease management, including lost wages, according to a new report from GoodRx Health. These...Avoidable Hospitalizations Less Common in Medicare Advantage, Study Finds
Medicare Advantage beneficiaries were less likely to have avoidable hospitalizations than those in traditional Medicare, suggesting that the use of provider networks in Medicare Advantage may reduce...Sponsored by Zelis