The payment integrity (PI) industry plays a critical role in US healthcare, ensuring that claims adjudication is accurate and that physicians and health systems are reimbursed correctly for care delivery. We estimate the $9 billion industry has grown at a 7 percent CAGR in recent years, reflecting growth in US healthcare spending and persistent complexity…

As we described in Part 1 of this article, specialty care providers have had limited opportunities to date for engagement in accountable care models, such as accountable care organizations (ACOs), despite their critical contributions to patient care. This is a missed opportunity for payment reform, given the growing breadth and reach of ACOs and the…

What You Should Know: – Medical Home Network (MHN), a leading care enablement partner for FQHCs, announced that its partners participating in the NeueHealth Premier ACO achieved $10.1 million in gross savings and a perfect 100% quality score in the 2022 performance year. – This accomplishment, under the ACO Realizing Equity, Access, and Community Health…

Guidehealth, a value-based care enablement startup, bought Arcadia’s managed service organization and value-based care service division to build out its tools and service for providers. Guidehealth also is partnering with Arcadia, a healthcare technology company that provides a data platform to providers and payers, to use the company’s data analytics platform to power its newly acquired offering….

State health care regulators at the Green Mountain Care Board have cut the annual operating budget for OneCare Vermont for the second year in a row, citing ongoing questions about the effectiveness of the accountable care organization and how executives are compensated, as well as about what the organization’s future role in the state will…

Accountable care models serve as the cornerstone of value-based approaches to expand access to well-coordinated, high-quality, and longitudinal care. Specialist engagement in these models is critical given the increasing role of specialists in managing care across the patient journey, the growing importance of specialized diagnostics and early disease interventions (such as biologics and cell and…

More than 80% of C-suite executives from healthcare and life sciences organizations see improved health equity as a top-10 goal for 2024, a recent report by Deloitte found. The report offered a 2024 outlook for health equity across the two industries and relied on data from a survey conducted by the Deloitte Center for Health…

Researchers warn generative AI could add $43 billion annually to America’s already stark racial wealth gap over the next two decades, with Black workers also facing a higher risk of job loss thanks to automation. Why it matters: The wealth gap between Black households and white households has widened since 1980 in the U.S., where…