Category: Case Management

  • Why Health Plans Must Have Next-Gen CAPS Technology for Digital Transformation

    Sagnik Bhattacharya Chief Operating & Product Officer HealthEdge Core Administrative Processing Systems (CAPS) operate as the brains behind a health plan’s business. These systems are critical to the smooth functioning of a health plan. Today, many payers run on decades-old CAPS systems built on legacy technologies. This can be a serious drawback.  Legacy systems may […]

  • Next Generation of Risk Adjustment: Uniting Health Plans and Providers

    Shahyan Currimbhoy, VP at Edifecs Aaron Fulner, Sr. Director at Edifecs Up until now, risk adjustment has been addressed as a mechanism to accurately represent the overall risk profile of a health plan’s membership. A function that will still facilitate a health plan’s payment for taking on at-risk populations is about to go through its first major transformation – the use of risk adjustment data to drive value-based […]

  • Time and Goals Should Drive Your Post-COVID-19 Care Management Strategy

    Jessica Scruton, BSN, RN, CCM, VP of Clinical Transformation for Lightbeam Health Solutions COVID-19 forced many health systems to reassess and reconfigure their care management processes and staffing models so that clinicians could better manage more of their acute, complex, and otherwise healthy patients remotely to limit in-person care.  During this time, health systems likely […]

  • How Care Coordination Technology Addresses Social Isolation in Seniors

    Jenifer Leaf Jaeger, MD, MPH, Senior Medical Director, HealthEC Senior isolation is a health risk that affects at least a quarter of seniors over 65. It has become recognized over the past decade as a risk factor for poor aging outcomes including cognitive decline, depression, anxiety, Alzheimer’s disease, obesity, hypertension, heart disease, impaired immune function, […]

  • VHA, Ontrak Launch 3-Year AI Study to Help Prevent Veteran Suicide

    What You Should Know: – The Veterans Health Administration has selected Ontrak in collaboration with Harvard Medical School and Brown University to transform suicide prevention care for veterans. – Leveraging AI developed by a Harvard Medical School professor and the core analytics of the Ontrak platform, the three-year study will look at the effect of […]

  • The Future of the ICU? How Clinical Decision Support Is Advancing Care

    Kelly Patrick, Principal Analyst at Signify Research Without a doubt 2020 has been a devastating year for many; the impact of COVID-19 on both personal lives and businesses has had long-term consequences. At the end of September, the number of COVID-19 cases fell just short of 350 million, with just over 1 million deaths reported. […]