Blog

Healthcare costs are already skyrocketing and creating a challenging crisis for the industry. The disparities in the U.S. healthcare system forge an unnecessary rise in costs that spreads over society, resulting in a financial crisis. The continuing upward trend in costs could lead to an even more significant number of unaffordable bills and deteriorating health...Read More

Risk adjustment has incentive insurance companies to provide memberships to patients who need it the most by “adjusting” the risk of enrolling chronically ill people along with healthier patients, ensuring that providers are adequately compensated according to each patient’s underlying health patterns, and the care provided. To ensure a mutually beneficial risk adjustment program, payers...Read More

Even though the Social Determinants of Health (SDoH) and health equity have received a great deal of interest from the healthcare industry in the recent years, the Biden administration is overhauling the contentious Direct Contracting Model to include additional conditions aimed at addressing the health equity model of accountable care and assuaging progressive legislators’ worries...Read More

Primary Care First (PCF) intends to increase primary care professionals’ self-governance by providing more operational adaptability and performance-based incentives, allowing them to customize care delivery depending on their specific patient groups and resources. The concept actively encourages providers to invest additional time with patients and offer coordinated, effective care by connecting health outcomes for patients...Read More

As CMS moves towards 100% encounter data in risk adjustment calculations next year, the ability to extract relevant information from clinical records will become paramount. While payers dread this upcoming change in Medicare Advantage and Part D calculations, all is not lost. In this article, we will identify a few key innovations these organizations can...Read More