Payer Systems

Why Is Medicare Advantage Overpayment and Fraud So Hard to Stop?
Management & Administration Why Is Medicare Advantage Overpayment and Fraud So Hard to Stop?

The Medicare Advantage program, designed to provide seniors with an alternative to traditional Medicare, has faced persistent issues of overpayments and fraud for over a decade. Despite the numerous efforts by the Centers for Medicare & Medicaid Services (CMS) to address and rectify these areas,

Can Collaboration Transform Healthcare Delivery with Longitude Health?
Management & Administration Can Collaboration Transform Healthcare Delivery with Longitude Health?

Healthcare in today's rapidly evolving environment faces numerous challenges, from rising costs to the need for more personalized, effective treatments. The launch of Longitude Health, a collaborative initiative by four major nonprofit health systems, aims to address these issues head-on through a

Blueprint for AI: DiMe, Google, and Mayo Clinic's Healthcare Playbook
Management & Administration Blueprint for AI: DiMe, Google, and Mayo Clinic's Healthcare Playbook

In the rapidly evolving landscape of healthcare, artificial intelligence (AI) stands out as a transformative force. Despite its potential, the effective implementation of AI remains a challenge for many healthcare systems. To address these challenges, the Digital Medicine Society (DiMe), Google,

Survey Reveals Costly Failures in Healthcare IT, Growing Financial Strain
Management & Administration Survey Reveals Costly Failures in Healthcare IT, Growing Financial Strain

An eye-opening survey by Black Book Market Research has exposed the increasing financial burdens that inefficient healthcare IT systems place on the industry. Gathering insights from 907 healthcare technology professionals, the study highlights technologies that not only fail to deliver expected

States Miss Key Opportunities in Medicaid Maternal Health Coverage
Management & Administration States Miss Key Opportunities in Medicaid Maternal Health Coverage

Recently, a report from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has highlighted missed opportunities by states to improve maternal health access through Medicaid managed care organizations (MCOs). The report points out significant gaps in insurance

Vermont Pursues Comprehensive Healthcare Reforms Amid Financial Crisis
Management & Administration Vermont Pursues Comprehensive Healthcare Reforms Amid Financial Crisis

The state of Vermont is navigating a profound healthcare crisis that has necessitated comprehensive reform efforts aimed at revitalizing its healthcare system. Spearheaded by the Green Mountain Care Board (GMCB), these efforts are driven by a critical need to achieve financial sustainability,

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