Dirk Garner

Listen Here: https://lnkd.in/gvE68x_i In today's podcast, we explore how optimizing provider data management (PDM) is key to boosting operational efficiency for health plans. Parvathy Sashidhar, Senior Director of Product Management for HealthEdge, dives into the common challenges plans face with outdated provider information and how these issues can be mitigated. Learn how advanced PDM solutions can streamline data integration and ensure accurate provider details, ultimately improving care delivery and strategic growth. This episode is sponsored by HealthEdge (https://healthedge.com/). For more information about Becker's Healthcare, please contact Jessica Cole or Scott Becker. #podcast #healthcare #womensleadership #innovationinhealthcare

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"Provider data management also helps in enhancing member experience. Members rely heavily on the provider directories to locate and identify in-network providers for accessing care. It is important that these directories are accurate and current to reduce the burden on customers." Listen to the most recent episode of the Becker's Healthcare podcast to learn more about how advanced Provider Data Management solutions can help healthcare payers streamline data integration and ensure accurate provider details to improve care delivery. Thank you so much to Becker's Healthcare for the feature, and Parvathy Sashidhar for sharing her knowledge! #HealthcarePodcast #ProviderDataManagement #HealthcareInnovation

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As California's largest nonprofit health data network, Manifest MedEx is integral to the state's health data infrastructure, combining and delivering crucial health information to help Medi-Cal managed care plans (MCPs) succeed under CalAIM. Learn what Medi-Cal MCPs can do with MX. https://lnkd.in/dqCsmBkz

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Catch this webinar replay! With upcoming requirements that help streamline and automate prior authorization, the industry is facing considerable challenges to scale connectivity between payers and providers rapidly. During this webinar, leading experts from Itiliti Health and eHealth Exchange discuss the best ways to create scalable connectivity between healthcare providers and payers. Watch here: https://lnkd.in/g58CHky5 #priorauth #priorauthorization #AIinHealthcare

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"𝗗𝗶𝘀𝗽𝗮𝗿𝗮𝘁𝗲 𝘀𝗼𝘂𝗿𝗰𝗲𝘀 𝗼𝗳 𝘂𝗻𝘀𝘁𝗿𝘂𝗰𝘁𝘂𝗿𝗲𝗱 𝗱𝗮𝘁𝗮, 𝘄𝗵𝗶𝗰𝗵 𝗮𝗯𝗼𝘂𝗻𝗱 𝗶𝗻 𝗵𝗲𝗮𝗹𝘁𝗵𝗰𝗮𝗿𝗲, 𝗮𝗿𝗲 𝗻𝗼𝘄 𝗮𝘀𝘀𝗲𝘁𝘀 𝘁𝗼 𝗽𝗼𝘄𝗲𝗿 𝗴𝗲𝗻𝗲𝗿𝗮𝘁𝗶𝘃𝗲 𝗔𝗜." This article is all about the honeymoon fit of unstructured healthcare data & generative AI. Data entry done manually by providers (especially into EMRs & payer portals) is becoming a thing of the past. Prior authorization & claims processing are still in the lead as the two top areas that providers are implementing automation & AI for within the back-end of the revenue cycle. 𝘗.𝘚. 𝘍𝘦𝘦𝘭𝘪𝘯𝘨 𝘨𝘪𝘥𝘥𝘺 𝘢𝘣𝘰𝘶𝘵 𝘵𝘩𝘦 𝘶𝘱𝘤𝘰𝘮𝘪𝘯𝘨 𝘩𝘦𝘢𝘭𝘵𝘩𝘤𝘢𝘳𝘦 𝘢𝘶𝘵𝘰𝘮𝘢𝘵𝘪𝘰𝘯 𝘦𝘷𝘦𝘯𝘵 𝘪𝘯 𝘦𝘹𝘢𝘤𝘵𝘭𝘺 𝘵𝘸𝘰 𝘥𝘢𝘺𝘴. 𝘖𝘷𝘦𝘳 450+ 𝘩𝘦𝘢𝘭𝘵𝘩𝘤𝘢𝘳𝘦 𝘭𝘦𝘢𝘥𝘦𝘳𝘴 (𝘢𝘯𝘥 𝘤𝘰𝘶𝘯𝘵𝘪𝘯𝘨) 𝘢𝘳𝘦 𝘫𝘰𝘪𝘯𝘪𝘯𝘨 𝘪𝘯. 𝘊𝘩𝘦𝘤𝘬 𝘰𝘶𝘵 𝘵𝘩𝘦 𝘥𝘦𝘵𝘢𝘪𝘭𝘴 𝘪𝘯 𝘵𝘩𝘦 𝘤𝘰𝘮𝘮𝘦𝘯𝘵𝘴 𝘣𝘦𝘭𝘰𝘸. 𝘕𝘰𝘵 𝘰𝘯𝘦 𝘺𝘰𝘶 𝘸𝘢𝘯𝘵 𝘵𝘰 𝘮𝘪𝘴𝘴! #mckinsey #ai #healthcare McKinsey & Company

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The cloud is no longer just a destination – it is an operating model for the future. Redox helps you unlock Snowflake's promise and mission to improve healthcare and life science outcomes. Learn more about our new technology partnership all around interoperability and real-time, actionable data. https://lnkd.in/e4ttrsU3

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#Integration, #continuity, and #Interoperability are key topics in healthcare Check out this conversation with Andrew Munroe ⬇ ⬇⬇

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In a recent webinar in Deloitte, we broke down the transaction requirements that are part of the newly finalized CMS rule on electronic prior auth. Catch a short clip below, and watch the full replay here: https://lnkd.in/gzP-h4dV #healthtech #priorauth #priorauthorization

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HEDIS aims to elevate measurement standards and enhance the quality of patient care. It is one of the most important tools in the payers' toolbox, so walking through the "what, how, and why" behind HEDIS is incredibly valuable. Read the blog for details: https://okt.to/FBkERU

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How can your health plan digitally engage members with consumer-grade experiences that rival out-of-industry CX leaders? Check out Kathleen McQuade Ellmore's session at League Connect to learn how! #memberengagement #digitalengagement #medicare

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What an insightful conversation on the path to consumer-grade engagement in healthcare! We couldn't agree more that healthcare organizations that want to excel need to be authentic and trustworthy. They need to have the right data and technology in place, a single source of truth to enable the engagement that consumers expect today that will also allow them to scale and continue to deliver the moments that matter in the future. 𝘛𝘩𝘦 𝘦𝘹𝘱𝘦𝘤𝘵𝘢𝘵𝘪𝘰𝘯𝘴 𝘧𝘳𝘰𝘮 𝘤𝘰𝘯𝘴𝘶𝘮𝘦𝘳𝘴 𝘢𝘯𝘥 𝘤𝘶𝘴𝘵𝘰𝘮𝘦𝘳𝘴 𝘸𝘪𝘭𝘭 𝘬𝘦𝘦𝘱 𝘰𝘯 𝘪𝘯𝘤𝘳𝘦𝘢𝘴𝘪𝘯𝘨, 𝘦𝘴𝘱𝘦𝘤𝘪𝘢𝘭𝘭𝘺 𝘢𝘳𝘰𝘶𝘯𝘥 𝘵𝘩𝘦 𝘮𝘰𝘳𝘦 𝘱𝘦𝘳𝘴𝘰𝘯𝘢𝘭𝘪𝘻𝘦𝘥 𝘥𝘪𝘨𝘪𝘵𝘢𝘭 𝘦𝘯𝘨𝘢𝘨𝘦𝘮𝘦𝘯𝘵. 𝘚𝘰, 𝘢𝘯𝘺 𝘪𝘯𝘷𝘦𝘴𝘵𝘮𝘦𝘯𝘵 𝘪𝘯 𝘵𝘩𝘢𝘵 𝘴𝘱𝘢𝘤𝘦 𝘪𝘴 𝘱𝘳𝘰𝘣𝘢𝘣𝘭𝘺 𝘨𝘰𝘪𝘯𝘨 𝘵𝘰 𝘩𝘢𝘷𝘦 𝘢 𝘩𝘪𝘨𝘩 𝘳𝘦𝘵𝘶𝘳𝘯 𝘰𝘯 𝘪𝘯𝘷𝘦𝘴𝘵𝘮𝘦𝘯𝘵. 𝘛𝘩𝘦 𝘫𝘰𝘶𝘳𝘯𝘦𝘺-𝘣𝘢𝘴𝘦𝘥 𝘢𝘱𝘱𝘳𝘰𝘢𝘤𝘩 𝘸𝘪𝘭𝘭 𝘴𝘰𝘳𝘵 𝘰𝘧 𝘣𝘦𝘤𝘰𝘮𝘦 𝘵𝘩𝘦 𝘯𝘰𝘳𝘮, 𝘮𝘰𝘮𝘦𝘯𝘵𝘴 𝘵𝘩𝘢𝘵 𝘮𝘢𝘵𝘵𝘦𝘳 𝘢𝘯𝘥 𝘸𝘪𝘯𝘯𝘪𝘯𝘨 𝘵𝘩𝘰𝘴𝘦 𝘮𝘰𝘮𝘦𝘯𝘵𝘴 𝘣𝘦𝘤𝘰𝘮𝘦𝘴 𝘵𝘩𝘦 𝘯𝘰𝘳𝘮. - Jigar Shah, SVP & Chief Marketing Officer, Blue Shield of California 𝘐𝘵 𝘩𝘢𝘴 𝘵𝘰 𝘣𝘦 𝘩𝘺𝘱𝘦𝘳-𝘱𝘦𝘳𝘴𝘰𝘯𝘢𝘭𝘪𝘻𝘦𝘥, 𝘢𝘯𝘥 𝘸𝘦 𝘢𝘳𝘦 𝘨𝘦𝘵𝘵𝘪𝘯𝘨 𝘵𝘩𝘦𝘳𝘦. 𝘐𝘵 𝘤𝘰𝘮𝘦𝘴 𝘥𝘰𝘸𝘯 𝘵𝘰 𝘢𝘳𝘮𝘪𝘯𝘨 𝘵𝘩𝘦 𝘤𝘰𝘯𝘴𝘶𝘮𝘦𝘳 𝘸𝘪𝘵𝘩 𝘵𝘩𝘦 𝘪𝘯𝘧𝘰𝘳𝘮𝘢𝘵𝘪𝘰𝘯 𝘵𝘩𝘦𝘺 𝘯𝘦𝘦𝘥 𝘵𝘰 𝘮𝘢𝘬𝘦 𝘵𝘩𝘦 𝘤𝘩𝘰𝘪𝘤𝘦𝘴 𝘢𝘵 𝘦𝘷𝘦𝘳𝘺 𝘴𝘵𝘦𝘱 𝘰𝘧 𝘵𝘩𝘦 𝘸𝘢𝘺, 𝘢𝘯𝘥 𝘵𝘩𝘢𝘵’𝘴 𝘯𝘰𝘵 𝘫𝘶𝘴𝘵 𝘸𝘩𝘦𝘯 𝘵𝘩𝘦𝘺 𝘢𝘳𝘦 𝘣𝘦𝘪𝘯𝘨 𝘢 𝘱𝘢𝘵𝘪𝘦𝘯𝘵, 𝘪𝘵’𝘴 𝘵𝘩𝘦 𝘦𝘷𝘦𝘳𝘺𝘥𝘢𝘺 𝘤𝘩𝘰𝘪𝘤𝘦𝘴. - Kathleen McQuade Ellmore, Co-Founder & Managing Partner, Engagys LLC that Redpoint Global Inc. has the pleasure to partner with. 𝗟𝗶𝘀𝘁𝗲𝗻 𝘁𝗼 𝘁𝗵𝗲 𝗳𝘂𝗹𝗹 𝗰𝗼𝗻𝘃𝗲𝗿𝘀𝗮𝘁𝗶𝗼𝗻, 𝟮𝟱 𝘄𝗲𝗹𝗹-𝘀𝗽𝗲𝗻𝘁 𝗺𝗶𝗻𝘂𝘁𝗲𝘀: https://lnkd.in/eSSsPSrs #patientcentricity #patient360 #patientengagement #healthIT

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Looking for more comprehensive closed claims data representative of all payer types to support your safety, real-world evidence, and health economics and outcomes research? Introducing HealthVerity taXonomy, the nation’s most comprehensive, highly-curated and research-ready closed claims dataset. Learn more https://hubs.ly/Q02DbJVT0

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The rising tide of claim denials and prior authorization requirements is placing a heavy burden on healthcare providers and their patients. I recently spoke with HIT Consultant Media about why these issues persist and, more importantly, how to address them. Here's how we can start solving these challenges: -  AI and automation can simplify workflows, easing the administrative load and allowing providers to spend more time on patient care. -  Integrated systems make data accessible and accurate, allowing real-time policy alignment and reducing errors that lead to denials. -  Payer-provider partnerships are crucial. For example, making payer adjudication rules and medical policies accessible and easily understandable using AI at the point of care will lower the burden and cognitive load related to claims and prior authorization workflows. Novel solutions like these are applicable beyond these specific challenges. When we apply innovation across the ecosystem, we will start to see scalable change - and help build a healthcare system that’s efficient, affordable, and truly patient-centered. Check out the full interview linked in the comments. 

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I'm pleased to have been featured in Digital First® Magazine for an interesting conversation about my favorite topic: Creating a better world with better information! See the full article here: https://lnkd.in/gNwcrpdS #Data #DataforGood

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💡 Gain insights into the critical changes CMS applied to the Section 111 TPOC reporting process. Watch now on demand, Breaking down CMS’s Section 111 TPOC/WCMSA data collection process – what to know and how Verisk can help, and to learn how these TPOC/WCMSA changes will impact Section 111 reporting going forward. Watch here: https://ow.ly/kL2p30sBLI5 #CMS #Section111 #WCMSA #TPOC #Medicare #Verisk

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With more than 400 hospitals and 62,000+ physicians in California, sharing patient information is crucial to providing the right care at the right time. Watch our on-demand webinar featuring the California Medical Association, Manifest MedEx and Connecting for Better Health to learn more about the California Data Exchange Framework and how it can help promote collaboration and improve patient outcomes! https://bit.ly/45eziK7 #WeAreBambooHealth

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This week’s announcement of lowered prices for 10 negotiated drugs is projected to save Medicare billions, marking a positive step forward. However, there remains significant work ahead to tackle the root causes of escalating drug prices and out-of-pocket expenses for patients. It will be interesting to watch how the pharma value chain adapts to this shift in the coming months and the impact on patient out-of-pocket costs. [Link to the article for more details: https://lnkd.in/e_7wKpyb] #Medicare #healthcare #pharma #pricing #innovation

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#DataTip Today we're talking about how to understand gaps in your Medicare Advantage provider network. Why is this important? CMS mandates that organizations monitor their networks for compliance with the current requirements and inform their CMS Account Managers ✨upon✨ discovery that their network is out of compliance. In other words, it's a big deal! Tip 1 - Have a way to be notified when there is a deficiency. That way, you can quickly evaluate the situation and take action. Tip 2 - Use the 5 Ws to understand what caused the change in your network. This will help you in your conversations with CMS—and guide you in making informed decisions about how to move forward. Here are some quick questions to ask when you have a gap: Who: Who is the provider who changed? Who is impacted by the gap? Who can you contract with to quickly fill the gap? What: What is the specialty? What caused the gap? Was it a termination, a change in location, or possibly a data entry error? When: When did the deficiency first appear? How long has it been there? When do you need to add or modify providers to be compliant again? Where: Where is the deficiency located geographically? Is it impacting other lines of business? Will this change affect future expansion counties? Why: Why does this particular specialty + county combination have a gap? Are there any geographic issues that might explain why it is challenging to maintain adequacy? Last but not least, check out our toolkit for more questions to ask your team as you prepare for your HSD Audit and ongoing compliance. Get your copy now! https://okt.to/afeVOx #QuestForSuccess

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