providers

Babyscripts raises $12M, plans to expand to all 50 states

The maternal care startup is backed by major health systems including MemorialCare Health System, whose innovation arm led the most recent funding round. Babyscripts offers a mobile app providing education and resources for the pregnancy and postpartum journey.

Hackensack Meridian Health partners with NowPow to create SDOH referral program

The NowPow referral platform, which is integrated into the New Jersey-based health system’s EHR, will enable clinicians and other care team members to provide patients — whose socioeconomic conditions are negatively affecting their health — with referrals to community resources, like food banks or rental assistance.

HIMSS Digital: Future is bright for payer-provider-pharma collaboration

The pandemic made collaboration necessary between stakeholders that otherwise tend to be at odds with each other. But as partnerships grow, providers, payers and pharma companies must ensure they are working toward a clear-cut common goal, according to panelists at HIMSS 21 Digital.

Texas law eases prior auth burdens, but payers see it as a dangerous move

The law, which will take effect in September, prohibits payers from requiring pre-approval from certain providers. While providers believe the law will cut administrative burdens, and improve care delivery, payers say it could lead to patient harm.

Automating authorizations as patients return to care

“The entire healthcare industry was turned upside down by the pandemic. Procedures were pushed back, insurance companies gave policy holders a lot of mixed information. It has been a mess.” This is what one healthcare executive told us when we surveyed patients and providers on the state of patient access, in June 2021. Changing prior …

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Sema4 goes public via SPAC merger

With a goal of making precision medicine the standard of care at health systems, Sema4 struck a nearly $800 million deal with CM Life Sciences to go public. The company, which offers tools that combine genomic and clinical data to glean patient care insights, will get $500 million in cash proceeds to grow its business.

Report: First half of 2021 sees massive spike in number of data breach victims

Provider organizations accounted for 73% of all data breaches reported to the HHS in the first six months of 2021, impacting about 22.7 million individuals overall, a new report shows. This represents a 185% jump in individuals affected compared to the same period last year.

Report: Telehealth use plateaus, but still 38 times higher than pre-pandemic levels

Though telehealth use has dropped since hitting its peak last April, it has stabilized at a much higher level than before the pandemic, says a new report. But not all specialties utilize telehealth equally, with uptake especially high in psychiatry and substance use disorder treatment.

Federal agencies issue rule enforcing surprise billing ban

HHS, along with other federal agencies, have released the first set of regulations that ban surprise billing and out-of-network charges for several types of services. More regulations are expected, especially those pertaining to the independent dispute resolution process that providers and payers will have to undergo if they cannot agree on out-of-network claims payment.

Providers win deadline extension for use of CARES funds, but it may cause some confusion

The HHS has extended some of the deadlines for using provider relief funds and reporting on that use. Though the move is mostly positive for providers — who were clamoring for this extension — there may be some additional work required to prevent confusion.

Report: Which US markets are ripe for ‘payvider’ models? 

“Payvider” models — that is, collaborative arrangements between payers and providers — are growing in popularity. But not all markets are created equal with regard to payvider adoption and growth. In a new report, consultancy firm Guidehouse identifies the markets with the most opportunities for payviders.

Healthcare fintech M&A expected to boost patient experience, provider operations

M&A activity in the healthcare finance technology is heating up, evidenced by large transactions such as Cedar buying OODA Health and R1 RCM buying VisitPay. Experts agree that this activity won’t end anytime soon, and it will have a positive impact on providers and patients.

Where 5 CIOs see IT innovation heading as pandemic winds down  

The Covid-19 pandemic has upended the healthcare industry in a myriad of ways — including the focus of IT innovation. Healthcare CIOs are seeing IT innovation priorities shift to arenas like at-home care, data science and supply chain.

CMS’ price transparency rule offers providers, payers a win, too

Patients are not the only ones who will benefit from the price transparency rule — providers and payers can also gain competitive advantages as a result of the regulation. These include being able to deepen relationships with patients and support payment contract negotiations.

Enforcement landscape for HHS data-sharing rules is hazy, experts say

The HHS’ new interoperability and information blocking rules have been in effect for one week, yet how they will be enforced is unclear. But there are some clues that could provide a glimpse into what the enforcement landscape might look like, and the best thing providers and IT developers can do is be proactive, experts …

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Lawsuit: Like a “boa constrictor,” UnitedHealthcare squeezed anesthesia group out of competition

U.S. Anesthesia Partners has filed lawsuits against UnitedHealthcare in Colorado and Texas, accusing the payer of forcing it out of network and intentionally interfering with its relationships with providers in those states. But, according to UnitedHealthcare, the lawsuits are an attempt to get the insurer to meet the anesthesia group’s high rate demands.

Effort underway to help hospitals by suspending Medicare sequestration

Medicare sequestration is making headlines this week, as legislation to pause the 2% payment cuts moves through Congress. Here is a recap of what the sequester cuts are, why hospitals want it gone and how lawmakers are working to make that happen.

Hospitals to DOJ: UnitedHealth’s purchase of Change Healthcare will curtail competition

The American Hospital Association is urging the Justice Department to thoroughly review UnitedHealth’s intended acquisition of Change Healthcare. The transaction would reduce competition in the health IT arena and result in higher prices and lower quality of care, the hospital group says.

Rural hospitals contend with an expensive shift to digital amid shrinking margins

The Covid-19 pandemic has decimated hospital finances, and as a result, rural providers are forced to make key IT spending decisions with limited dollars. Here is a snapshot of how they will prioritize those dollars this year and the federal support they need to survive the ongoing public health crisis.

Providers look to predictive modeling to help rebuild finances in 2021

After a challenging 2020, health systems are looking to deploy strategies for recovery, especially to bolster financial health. One strategy health executives are considering is investing in predictive modeling technology that can help them manage patient demand and outcomes in the coming year.

14 major health systems launch data insights company

In an unusual move, 14 major providers — including Trinity Health, CommonSpirit Health and Tenet — have come together to launch a data analytics company. Insights derived from the company’s platform will be available to providers, biopharma companies and scientific researchers working to advance patient care.

What providers need to know about OIG’s plans to audit telehealth services

The Office of the Inspector General will audit Medicare Part B telehealth services to detect potential vulnerabilities and ensure compliance with regulatory requirements. To prepare, providers must first take stock of their programs and conduct audits of their own, experts say.

States threaten to crackdown on providers amid Covid-19 vaccine distribution

In an effort to ensure the efficient and orderly distribution of the Covid-19 vaccine, governors from New York, California and Florida are warning that they will take action against providers who are conducting vaccinations too slowly or healthcare workers who undercut priority guidelines.

Report: Covid-19 hospitalizations spiked amid falling operating margins in November

The financial futures of U.S. hospitals remain shaky, as Covid-19 cases and hospitalizations surge with alarming speed nationwide. Though vaccines are being distributed, the coming months will be challenging for hospitals, a new report from Kaufman Hall shows.

Financial strain, new modes of care delivery to drive provider consolidation through 2030

As a result of rapid consolidation, the 10 biggest health systems controlled 24% of market share based on patient revenue by 2018. The trend is expected to continue through the next decade, with health systems facing growing financial pressures and an increase in demand for new types of care delivery.

CMS proposed rule requires payers to streamline prior authorizations

The rule would require payers in the Medicaid, CHIP and QHP programs to build and maintain application programing interfaces to improve data exchange and the prior authorization process. But the rule does not include Medicare Advantage plans, which the American Hospital Association called “disappointing.”

CMS’ new Geo care delivery model: 5 things to know

The new Geographic Direct Contracting Model aims to improve quality of care and slash costs for Medicare beneficiaries across an entire region. It involves setting up risk-sharing arrangements where participants will be responsible for the total cost of care for beneficiaries in the region.

And the winners of INVEST Digital Health Virtual Pitch Perfect contest are…..

The INVEST Digital Health Virtual conference Pitch Perfect competition, from September 21-25, had some intense competition between the healthcare startup participants. Thanks to all the entrepreneurs, judges and sponsors who took part.