The Change Healthcare Podcast: Recent Episodes
Change Healthcare
Change Healthcare is a leading healthcare technology company, focused on accelerating the transformation of the healthcare system through the power of the Change Healthcare Platform. We provide data and analytics-driven solutions to improve clinical, financial, administrative, and patient engagement outcomes in the U.S. healthcare system. Learn more at changehealthcare.com.
VP and Head of Solutions at Nuna, Parag Patel, chats about how the Prometheus Episode Grouper from Change Healthcare has helped Nuna better serve all.
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- Follow Serrah Linares, vice president of partnerships at Change Healthcare
- Follow Parag Patel, VP and Head of Solutions at Nuna
- nuna.com
- changehealthcare.com/value-based-care/episode-manager
Thyme Care Co-Founder, President, and CMO, Dr. Bobby Green, joins host Yousuf Zafar, MD, to discuss how his team at Thyme Care are working to provide personalized care guidance to help cancer patients through their journey. Dr. Green also shares the importance of combining a human touch with technology to help improve lives and reduce care costs.
Learn More:
- Follow Dr. Bobby Green, co-founder, president and CMO at Thyme Care
- Follow Dr. Yousuf Zafar, senior vice president, medical informatics at Change Healthcare
- thymecare.com
- changehealthcare.com/data-analytics
Safr Care CEO, Syed Gilani, joins host Serrah Linares to discuss how Safr Care approaches the unique challenges they face, and how Change Healthcare helps Safr Care achieve its mission.
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- Follow Serrah Linares, vice president of partnerships at Change Healthcare
- Follow Syed Gilani, President and CEO of Safr Care
- safrcare.com
- marketplace.changehealthcare.com/products/eligibility_and_claims/eligibility
- changehealthcare.com/channel-partners
Founder and CEO of State of Reform, DJ Wilson, joins host Deanne Kasim to discuss the efforts underway to bring health plans, providers, and regulators together, with an emphasis on innovation.
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- Follow Deanne Kasim, VP of health policy at Change Healthcare
- Follow DJ Wilson, founder and CEO at State of Reformchangehealthcare.com/government-affairs
- changehealthcare.com/government-affairs
Quartz Health Solutions director of accreditation and quality insurance, Amy Bachhuber and senior director of Medicare operations, Mark Kirchberg join host Shelley Stevenson to discuss how they implement dual eligible special needs plans.
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- Follow Shelley Stevenson, director government programs practice at Change Healthcare Consulting
- Follow Amy Bachhuber, director of accreditation and quality insurance at Quartz Health Solutions
- Follow Mark Kirchberg, senior director of Medicare operations at Quartz Health Solutions
- changehealthcare.com/healthcare-consulting/government-programs-consulting
Sirona Strategies Partner Kristen Ratcliff McGovern joins host Deanne Kasim to discuss policy and legislative trends leading up to the midterm elections. McGovern shares the key issues Congress needs to focus on before the end of the year, as well as some pre- and post-election considerations.
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- Follow Deanne Kasim, vice president of health policy at Change Healthcare
- Follow Kristen Ratcliff McGovern, partner at Sirona Strategies
- sironastrategies.com
- changehealthcare.com/government-affairs
Luma Health co-founder and CEO Adnan Iqbal joins the Change Healthcare Podcast to discuss how and why his company created a digital patient engagement platform that empowers healthcare providers to differentiate themselves in a competitive market.
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Presented by Change Healthcare
www.changehealthcare.com
As COVID surged around the world, native Hawaiians were at an increased risk due to socioeconomic factors and comorbidities. To understand the work being done to support vulnerable Hawaiians, we spoke with Kevin Vaccarello to hear how Sustain Hawaii was able to use technology to expand their operation and support their mission of transforming the islands’ capacity for self-reliance.
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Presented by Change Healthcare
www.changehealthcare.com
With the new CMS and ONC regulations firmly in place, individual access is taking off. But there are still some tricky issues to address around consent and data segmentation. In this episode of the Let’s Talk Interop podcast, our panel explores how technology can support consent capture and revocation as well as consent sharing. They also dive into the work our industry is doing to create standardized ways to segment sensitive data so that patients can safely access their own data and caregivers can access data when needed.
As our public health emergency (hopefully) winds down, federal and state governments are reshaping healthcare policy. To gain clarity we sat down with Ceci Connolly, CEO for the Alliance of Community Health Plans to discuss federal and state healthcare policy trends around Medicaid, mental health, preauthorization and value-based care.
Get to know the newly released Trusted Exchange Framework and Common Agreement (TEFCA): what it is, what it does, and how it might impact nationwide interoperability.
While crossing professional paths over many years, health IT leaders Eric Lacy and Jim Schreiner became good friends—and learned advocates for the transition of enterprise imaging to the cloud. From their perspectives, informed by a radiology practice and a hospital setting respectively, they offer advice and optimism on what lies ahead on the path to the cloud. Tracy Byers, Senior VP and General Manager of the enterprise imaging business for Change Healthcare leads the conversation.
Mike Russell is the co-founder and CEO of Monument, an online treatment platform for those looking to change their relationship with alcohol. In this episode, Change Healthcare’s Anuj Desai talks with Mike about how his own experience drove him to create a new approach to alcohol treatment. Mike tells Anuj how his company was born and how technology has enabled an alternative care mode
For healthcare providers, the potential of cloud technology intrigues, yet adoption has proven difficult.
Nowhere is this more evident than in imaging, which has a legacy of aging, on - premise applications that interact with every point of care. Faced with unscalable solutions and limited alternates, many providers’ have stalled their initiatives.
Today’s enterprise cloud imaging solutions offer new hope. Here we discuss what’s next for cloud based medical imaging, outlining drivers and barriers to adoption.
We recently asked payers across the country about the No Surprises Act. What do they think about it? How are they preparing for it? How do they feel it will affect their business? In this inaugural episode of our government mandates theme — which we plan to record quarterly, or as critical updates become available — our panelists reflect on payers’ survey responses.
Join our presenters as they discuss the history and future of HEDIS reporting. Listen in to discover how existing pain points, regulatory agencies, and environmental factors are influencing the transition from claims-based to clinical-based measures.
Today’s panel includes: Genevieve Morris, senior director, clinical interoperability strategy at Change Healthcare; Robert Connely, vice president, business development, provider networks, clinical networks at Change Healthcare; Eric Whitley, independent health informatics consultant
Here’s what they chatted about:
- Why HEDIS was first established, how it’s evolved over the years, and where it’s headed
- How COVID-19 has affected the healthcare data landscape
- Moving from claims-based to clinical-based measures: Key considerations
- How market influences will inform the future of HEDIS and healthcare data
- What career path Genevieve would choose if she could go back 20 years
As a “free-range” child in the late ‘60s and early ‘70s, Dr. John Halamka rode his bicycle to the dumpsters of defense contractors, pulling out the integrated circuits they had thrown away. By age 14, he had gained an advanced understanding of technology, however his passion lied in biology and life sciences—which led to a “crazy idea”: “What if I made a career that brought together technology and service to patients?” Roughly a half century after his novel notion, Dr. Halamka joins Change Healthcare’s Tim Suther to share stories and lessons from the leading edge of incorporating social determinants of health (SDoH) and individual data into healthcare.
On today’s show, Dr. John Halamka joins Tim Suther to discuss gaps that exist between what we know about SDoH and individual-level data in healthcare, and how organizations are incorporating individual-level data to drive better care outcomes.
Today’s panel: Dr. John Halamka, president, Mayo Clinic Platform; and Tim Suther, senior vice president, data solutions at Change Healthcare.
Here’s what they chatted about:
- Why is the real-world healthcare experience still decidedly mixed despite knowledge that social determinates affect up to 80% of health outcomes?
- Lessons from the front lines of healthcare, including what works and what doesn’t.
- How we end up with incorrect or ineffective healthcare data, and the need for alternate sources of data.
- Incorporating social determinants into predictive algorithms, and where these algorithms are most likely to fail.
- Why “innovation without risk” is an unrealistic goal, and how organizations can approach innovation instead.
Why healthcare organizations need to make data security a priority, along with an approach Mayo Clinic uses to protect patient data.
In today’s episode, Tim Suther is joined by Dr. Mark Cullen, who’s been at the forefront of population health for decades—even before it was a recognized field. Listen in as Tim and Dr. Cullen discuss the collaborative effort that has gone into the COVID-19 Research Database, and what the resulting research and analysis can tell us about vaccine effectiveness, breakthrough infections, social determinants of health (SDoH), and booster vaccines.
Today’s panel includes: Dr. Mark Cullen, consultant in population health and the Founding Director of the Stanford Center for Population Health Sciences; and Tim Suther, senior vice president, data solutions at Change Healthcare.
Here’s what they chatted about:
- What data can tell us about COVID-19 vaccine effectiveness and breakthroughs, and what it can’t.
- What’s behind vaccine hesitancy and where we go from here.
- How social determinants of health (SDoH) and pre-existing conditions have affected infection and mortality rates.
The US Government is poised to make groundbreaking federal and state policy decisions. Special guest Matt Salo, executive director of the National Association of Medical Directors, joins us to discuss the latest congressional action on the infrastructure package, challenges of current budget reconciliations, and Medicaid expansion consideration. We also explore critical state health and health tech topics including the growing data privacy and security policy efforts, state public option models, COVID vaccine hesitancy, how Medicaid programs have addressed public health needs, and what’s next for telehealth policy in states.
Analytics are key to success in value-based care. That’s because analytics deliver data-driven insight into exactly what it takes to achieve desired patient outcomes for any given episode of care. With that insight, payers and providers can collaborate to move more smoothly from fee-for-service to fee-for-value, to create logically bundled payment programs, and to produce insight-driven results. So learning more about VBC analytics will help you reap more of VBC’s potential benefits.
Analytics are key to success in value-based care. That’s because analytics deliver data-driven insight into exactly what it takes to achieve desired patient outcomes for any given episode of care. With that insight, payers and providers can collaborate to move more smoothly from fee-for-service to fee-for-value, to create logically bundled payment programs, and to produce insight-driven results. So learning more about VBC analytics will help you reap more of VBC’s potential benefits.
Presenters:
Summerpal Kahlon, MD, VP Value-Based Payment at Change Healthcare
Kyle Kroening, Product Manager, NetworX Product Suite at Cognizant
Jennifer Mann, Senior Manager, NetworX Product Management Team at Cognizant
Would you order something online but not expect to know the cost until after the item is delivered? The answer is probably, no! For years, healthcare costs have been a mystery, not revealed until after services were completed. Now, with the shift to cost transparency in healthcare, consumers are acquiring the tools to get advanced pricing on healthcare services. Two important federal regulations are helping to drive this new normal.
In this episode, host Ed Domansky talks with Mike Peresie about the opportunities and challenges payers face in implementing price transparency in healthcare. Mike is the senior vice president and general manager of the Medical Network business at Change Healthcare.
Consumers expect digital access to providers to be on par with their online retail experiences. After all, they're footing the bill for healthcare under their high-deductible health plans. And o providers today need a “digital front door” that attracts and retains patients, and ultimately drives revenue. Today’s show brings together healthcare leaders from Adobe, Microsoft, and Change Healthcare to discuss this new normal, and what providers need to know to be successful with a digital-front-door strategy.
Today's panel features Ivy Portwood, principal marketing manager at Adobe; Tracy Picon, senior director with Microsoft’s U.S. Health and Life Sciences group; Tom Swanson, heads of Adobe’s Health and Life Sciences strategy and marketing; and Patrick Leonpacher, business development and operations executive with Change Healthcare.
Here's what they discussed:
- Why digital front door matters
- Patient self-help capabilities
- Components of a digital front door
- How to use digital tech to empower patients
- How to improve healthcare accessibility
- What healthcare leaders can learn from retail
- Why personalization aids patient retention
- How to bring price transparency into the patient experience
- Keeping the human touch in a digital world
Episode Resources
- Ivy Portwood’s bio
- Tracy Picon’s bio
- Tom Swanson’s bio
- Patrick Leonpacher’s bio
- Unlocking Patient Access
- Price Transparency
- Healthcare E-commerce Platform
- Paradox-of-Choice Report
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Paper checks comprise about one-third of all payments from health plans to providers. They’re accompanied by printed remittance information, which adds to the costs of printing, mailing and depositing checks. How can healthcare convert more payments from paper to electronic formats? In part one of a two-part series, host Brian Andrews, along with colleagues Dan Pay and Mark Zurline, discuss new technology that simplifies payment processing and posting.
Brian Andrews is Change Healthcare’s senior vice president of provider network development. He joins Dan Pay, vice president of strategy and management operations; and Mark Zurline, senior director of payments product management, in this compelling discussion about the latest advances in payment processing.
They discuss:
- The financial scale of healthcare’s paper-check problem
- Why paper checks persist in healthcare
- Takeaways from converting paper claims to electronic
- Inside the National Payments Connector (NPX)
- The hidden value of one-time enrollment
- How to consolidate remittances to a central portal
- Considerations for system security
Episode Resources
- Brian Andrews’ bio
- Dan Pay’s bio
- Mark Zurline’s bio
- National Payments Connector
- Phasing Out Paper Checks
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
HIPAA sets a floor rather than a ceiling for how patient privacy works state by state. Human factors also add complexity to policy under the law in areas such as clinical trials and substance abuse treatment. Today's guest David Finney is joined by Deanne Kasim and Arien Malec to explore how efficient exchange of personal data, proven in existing technology and innovative networks, offers the promise of information sharing at reduced cost.
David Finney is co-founder and partner of Leap Orbit. Deanne Kasim is executive director of health policy at Change Healthcare. Arien Malec is senior vice president of product development at Change Healthcare.
Here's what they discussed.
- Forms of data use authorized by HIPAA
- HIPAA’s patchwork of privacy protections
- Patient authorization’s role in HIPAA
- Information that requires patient authorization
- HIPAA’s de-identified data standard
- Technology for documenting patient privacy directives
- A complicating factor in authorization
- State approaches to data collection
- Policy recommendations for data exchange
- A preemptive national health privacy law
Episode Resources
- David Finney’s bio
- Deanne Kasim’s bio
- Arien Malec’s bio
- Leap Orbit
- HIPAA resource for professionals
- California CCPA
- Change Healthcare Government Affairs
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Disclaimer: The information provided within this podcast does not, and is not intended to, constitute legal advice. Instead, all information, content, and materials are for general informational purposes only. Listeners should contact their attorney to obtain advice with respect to any particular legal matter.
Today 37% of the U.S. is vaccinated. But how do you verify that? What vaccine was given? How do you schedule follow ups? What about vaccinations for other diseases? Vaccine credentialing is one answer, but healthcare credentials issued by different organizations need to be consistent, interoperable, private, and secure. On today’s show, Ramesh Raskar, PhD, and Kris Joshi look at the present and future of healthcare credentialing, the challenges, and the opportunities for population health.
Today’s panel features Ramesh Raskar, PhD, founder of the PathCheck Foundation; and Kris Joshi, executive vice president and president of Network Solutions at Change Healthcare.
Here's what they discussed.
- U.S. vaccine hesitancy compared to other countries
- Issuing and using vaccine credentials
- Integrating credentialing into the public health infrastructure
- Preparing for outbreaks and booster-shot programs
- Considerations for interoperability and the consumer experience
- Lessons to be learned from other countries
- Crowdsourcing to close public health IT gaps
Episode Resources
- Ramesh Raskar’s bio
- Kris Joshi’s bio
- The PathCheck Foundation
- Uber-izing the COVID Vaccination Experience
- CDC COVID Vaccinations U.S. Data Tracker
- CDC’s Child and Adolescent Immunization Schedule
- CDC’s Adult immunization Schedule
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Can states build models of health policy innovation supported by federal investment? Early efforts are under way to bring health plans, providers, and regulators together, with an emphasis on innovation. State of Reform’s DJ Wilson joins Deanne Kasim and panelists Angela Evatt, Steve Brennan, and Matt Keppler to discuss the components driving this approach among emerging federal and state legislation.
Today’s special guest is DJ Wilson, founder and CEO of State of Reform. DJ joins Change Healthcare’s Deanne Kasim, executive director of health policy; Angela Evatt, director of state health policy; Steve Brennan, Wester Region senior manager of state health policy; and Matt Keppler, Central Region senior manager of state health policy.
They discussed:
- Policy takeaways from Biden administration’s first 100 days
- Public health investment opportunities in upcoming infrastructure legislation
- The post-pandemic outlook for value-based care
- Where states are working with federal partners
- Status of state data privacy bills
- Progress on health information exchange legislation
- Public option efforts to control healthcare costs
- Legislative activity on vaccination credentialing
- Employers requiring proof of vaccination
Episode Resources
- DJ Wilson’s bio
- Deanne Kasim’s bio
- Angela Evatt’s bio
- Steve Brennan’s bio
- Matt Keppler’s bio
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
After years of slow to no progress, clinical interoperability is being propelled forward by consumer and competitive market pressures, and an array of federal mandates. On today’s show, host Charles Pelton talks with Genevieve Morris about the evolution of clinical interoperability, where it started, where we are today, and where the industry is headed.
Genevieve Morris is Sr. Director of Clinical Interoperability Strategy at Change Healthcare. She previously worked as a healthcare IT and policy consultant and advisor, and worked on the development of regulations at the U.S. Office of the National Coordinator for Health Information Technology. Charles Pelton is an independent industry analyst and event host.
They review:
- The impact of “information blocking” rules
- Policy or technical challenges: which is the inhibitor?
- Standardizing core healthcare data
- What data remains to be standardized
- How the federal standards-setting process works
- When real-time healthcare data access is important (and when it isn’t)
- How and when data interoperability makes a clinical difference
- Building trust between healthcare organizations
- A role for AI
Episode Notes
- Genevieve Morris’s bio
- Charles Pelton’s bio
- Why Clinical Interoperability Between Providers and Payers Is so Important
- Clinical Interoperability Is Happening: How Will You Respond?
- Everything You Dare to Ask About Healthcare Interoperability
- CommonWell Health Alliance
- Clinical Document Collector API
- Change Healthcare Developer’s Marketplace
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
An ONC brief finds healthcare made significant progress on data sharing. But that connectivity is largely between EHRs. Today’s panel draws a distinction between simple EHR data sharing and truly interoperable healthcare services that are usable and extensible via FHIR across myriad vendor, payer, and provider solutions. Lisa Bari, interim CEO at the Strategic Health Information Exchange Collaborative, joins our Change Healthcare panel to look at progress across the national interoperability policy agenda.
Our panel: Lisa Bari, interim chief executive officer at the Strategic Health Information Exchange Collaborative and Change Healthcare executives Deanne Kasim, executive director of Healthcare Policy; Arien Malec, senior vice president of Product Development; and Genevieve Morris, senior director of Clinical Interoperability Strategy.
They talk about:
- The latest on interoperable health data and health information exchanges (HEI)
- Use cases for public health data and access
- Study finds business cases to promote interoperability lacking
- Why interoperability incentives and penalties are failing
- Ways to accelerate interoperability nationally
- How to level the HIE playing field
- Technology, policy, and trust issues that must be solved
- A public utility model for HIEs
- Implications of the 21st Century Cures Act on interoperability
Episode Resources
- Lisa Bari’s bio
- Deanne Kasim’s bio
- Arien Malec’s bio
- Genevieve Morris’ bio
- Change Healthcare Government Affairs
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
The Protecting Access to Medicare Act (PAMA) ties imaging reimbursement to using clinical decision support (CDS) to help ensure medical necessity. But why stop there? On today’s show, Dr. Ryan Lee with the Einstein Healthcare Network in Philadelphia shares how Einstein has gone beyond compliance to embrace a broad and collaborative use of CDS.
Dr. Ryan Lee is an associate professor of radiology at Thomas Jefferson University and leads radiology, quality, and safety programs at the Einstein Healthcare Network in Philadelphia. Greg Mogel is the chief medical officer for CareSelect at Change Healthcare.
They discuss:
- CDS's impact on compliance, cost, and quality
- Substituting medical evidence for anecdotal judgment
- Going beyond radiology
- Lessons learned about the keys to CDS success
- Determining the best study, the wrong study, or no study
- Streamlining preauthorization for commercial insurers and Medicare
- Applying CDS to pediatric cases
- Reducing unnecessary imaging, costs, and exposure to radiation
Episode Resources
- Ryan Lee’s bio
- Greg Mogel’s bio
- CareSelect Imaging
- Bringing Clinical Decision Support to Imaging to Assure PAMA Compliance
- Audiobook: Aligning the Lab with the Hospital’s Strategic Priorities
- Your PAMA Questions Answered
- Audiobook: The New PAMA Math
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Today Jen Covich Bordenick, CEO of the eHealth Initiative, helps us assess the Biden administration’s ambitious 100-day agenda for combating COVID-19. She joins Change Healthcare’s Deanne Kasim, Angela Evatt, and Steve Brennan to discuss how COVID-19 is now central to everything happening with healthcare policy legislation and executive orders at the federal and state government levels.
Our panel: Deanne Kasim is executive director of Healthcare Policy, and Angela Evatt and Steve Brennan are senior managers of State Health Policy at Change Healthcare. They’re joined by Jen Covich Bordenick, the CEO of the eHealth Initiative.
Topics discussed on today’s show:
- Progress on vaccine distribution and related public health issues
- Vaccination appointments and the healthcare digital divide
- Legislation to address disparities in access to care
- Momentum for permanent waivers expanding telehealth access and payment
- The potential for “asynchronous” remote care coverage
- Privacy issues with COVID-19 tracking data and apps
- Public health infrastructure weaknesses exposed
- State healthcare bills and policy focus
- State budget challenges and federal funding uncertainty
Episode Resources
- Jen Covich Bordenick’s bio
- Deanne Kasim’s bio
- Angela Evatt’s bio
- Steve Brennan’s bio
- eHealth Initiative
- CDT and eHI Release Proposed Consumer Privacy Framework for Unprotected Health Data
- Change Healthcare Government Affairs
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Just 14% of organizations emerge from an economic downturn in better shape than they were before the slump, according to a recent study by the Harvard Business Review. But the study also found that companies that adopted a “progressive focus” will outperform rivals during and after a downturn.
On today’s podcast, Kevin Brooks and Jeanette Flom consider the role of digital transformation as a strategy to help organizations emerge from the downturn stronger and better prepared for the future of healthcare.
Today's panel: Kevin Brooks is senior vice president of marketing at Change Healthcare. Jeanette Flom is senior vice president of client engagement at AVIA.
Kevin and Jeanette cover:
- Digital transformation and the COVID-19 pandemic
- Unlocking digital strength in an economic downturn
- Three strategic pillars to improving digital patient experiences
- Increasing back-office efficiency with digital innovation
- The differences between digital projects and a digital organization
- Setting priorities for digital transformation efforts
- The role of digital in the changing nature of healthcare
Episode Resources
- Jeanette Flom’s bio
- Kevin Brooks’ bio
- AVIA Health
- AVIA Connect
- 4 Ways to harness Digital Solutions
- A Playbook to “Being Digital” in Healthcare
- Roaring Out of Recession
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
While a new administration addresses federal policy for the pandemic, vaccines, and more, the policy implementation remains largely with the states. Today’s guest is Hemi Tewarson, visiting fellow leading state health policy research at the Margolis Center for Health Policy at Duke University and former director of the National Governors Association Center for Best Practices Health Division. She discusses what changes to expect for healthcare policy, and how the states and industry can prepare.
Today’s panel features Deanne Kasim, executive director of Healthcare Policy at Change Healthcare; Arien Malec, SVP of Research and Development at Change Healthcare; and Hemi Tewarson, senior policy fellow at the Margolis Center for Health Policy at Duke University.
Here's what they discussed.
- The policy burden on states and how the federal government can help
- Policy issues put on hold during the pandemic that remain to be addressed
- The collision between surging demands and depleted state budgets
- The impact of predictable federal funding on health policy
- How to solve logistical challenges of vaccine distribution
- Overcoming public resistance to vaccination
- What’s next for telehealth policy
- How to institutionalize lessons learned from the pandemic
Episode Resources
- Hemi Tewarson’s bio
- Deanne Kasim’s bio
- Arien Malec’s bio
- Margolis Center for Health Policy at Duke University
- Supporting an Equitable Distribution of COVID-19 Vaccines: Key Themes, Strategies, and Challenges Across State and Territorial COVID-19 Vaccination Plans
- Change Healthcare Government Affairs
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
With the 2020 election in the rear-view mirror, what’s next for healthcare policy? Divided government at the federal and many state levels, and ballooning deficits, complicate the pandemic response even as a national vaccination program rolls out. Deanne Kasim invited Gov. Howard Dean, MD, former chairman of the Democratic National Committee, to join her in a panel discussion and share his views on what might come next for health policy.
Disclaimer: The views and opinions expressed by Governor Dean in this podcast are those of his own and do not purport to reflect the opinions, views, or official policies or positions of Dentons or Change Healthcare.
Today’s panel features Deanne Kasim, executive director, Health Policy; Angela Evatt, senior manager, Health Policy; and Steve Brennan, Senior Manager State Health Policy, for Change Healthcare. They were joined by Gov. Howard Dean, Senior Advisor, Public Policy, to the global law firm Dentons.
Here's what they talked about:
- Election analysis and implications for healthcare policy
- Obstacles to bipartisan policy action
- Pandemic relief prognosis
- Executive actions vs. legislation
- The challenging logistics of vaccine distribution
- State ballot initiatives related to healthcare policy
- Investment in public health infrastructure
- COVID-19 contact tracing
- Budget pressure on states
Episode Resources
- Gov. Howard Dean's bio
- Deanne Kasim's bio
- Angela Evatt's bio
- Steve Brennan’s bio
- Change Healthcare Government Affairs
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
The way health plans communicate with members today is strikingly similar to how they communicated 10, 20, even 30 years ago: mostly on paper via U.S. mail. Why are member communications largely stuck in the past while most other industries have aggressively shifted to digital engagement? A recent Harris Poll study of healthcare consumers found 71% of consumers now want their health plan to connect with them digitally, and that number will only grow as a result of the pandemic.
On today’s show, Phillip Cardona and Sally Love Connally discuss what payers need to do to bring member communications into the digital age, while meeting regulatory compliance and other business challenges unique to healthcare.
Phillip Cardona is strategy executive on the Payer Growth Program team at Change Healthcare. Sally Love Connally is senior vice president and general manager of Member Communications at Change Healthcare.
Here’s what they chatted about:
- How health plans are falling short of rising consumer expectations
- Shortcomings exposed by the pandemic
- Risks and rewards of digital member communication
- Old school vs. new school: Giving members choice
- Why health plans find omnichannel communication strategies challenging
- Regulatory restrictions and barriers, and how to overcome them
- Getting the basics right
- How to keep pace with a rapidly evolving member communications landscape
Episode Resources
- Phillip Cardona’s bio
- Sally Love Connally’s bio
- Change Healthcare Payer Growth Program
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
A source of inefficiency in U.S. healthcare is the process for detecting and correcting inaccurate insurance claims payments. Traditional approaches, based on claims auditing, use a “pay and chase” process to recover improper payments. On today’s program, Change Healthcare’s Phillip Cardona and Mike Spellman discuss alternatives to pay-and-chase, including an innovative approach that helps payers and providers work together to catch errors early, reduce administrative overhead, and improve payment accuracy.
Phillip Cardona is strategy executive for Change Healthcare’s Payer Growth Program. Mike Spellman is a senior director for Payment Accuracy Solutions at Change Healthcare.
Phil and Mike discuss:
- Contrasting traditional payment integrity and proactive payment accuracy programs
- How primary and pre-submission claims editing work with retrospective payment integrity reviews
- Efficiencies gained from identifying claims coding and payment errors earlier
- Why provider collaboration and transparency is essential
- The phases of payment accuracy maturity
- The role of technology in improving payment accuracy
- Leadership challenges for payers and providers
Episode Resources
- Phillip Cardona’s bio
- Mike Spellman’s bio
- Change Healthcare Payer Growth Program
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Research indicates the more methods a provider offers patients for remittance, the more likely the provider will be paid quickly. Why, then, have providers proven reluctant to embrace one of the newest and innovative methods of payment: virtual cards? On today’s show, Phillip Cardona and Bill Barbato reveal what virtual cards are, how they help providers get immediate payment of approved claims, why providers have been reluctant to embrace them, and why that reluctance might be fading.
Phillip Cardona is strategy executive for the Payer Growth Program at Change Healthcare. Bill Barbato is general manager and vice president of Payment Solutions at Change Healthcare.
Here's what they dug into:
- Payment options defined, pros and cons
- The link between payment options and bad debt
- How electronic payment speeds payer reimbursement
- Virtual cards defined
- How virtual cards work
- Where virtual cards fit in the array of provider payment options
- Why virtual cards have caught on elsewhere but not in healthcare
- Advantages of virtual cards for payers
- What’s next for healthcare fintech
Episode Resources
- Phillip Cardona’s bio
- Bill Barbato’s bio
- Change Healthcare Payer Growth Program
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Denials can be triggered by mistakes that occur before, during, or after a patient’s visit. Improvements before patient encounters can result in preventing the bulk of denials before they ever reach payers.
Episode Resources
- How to Improve Denial Management Throughout the Patient Journey (print version)
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
A special edition of the Change Healthcare Podcast
Today we're bringing you a live forum with the CEOs of HFMA, the Healthcare Financial Management Association, and AHIP, America's Health Insurance Plans.
Today's live forum is about Bridging the Consumer Experience Divide, where Matt Eyles, the CEO of AHIP, and Joe Fifer, the CEO of HFMA, join Change Healthcare’s Bill Krause to discuss how "consumer-first collaboration" can benefit all healthcare stakeholders.
People often focus on the competing business interests of health insurers and providers, but both are striving to achieve the same goals: to make healthcare accessible, affordable, and high quality. And today, payers and providers increasingly agree that these goals can't be achieved without it making it easier for consumers to digitally engage with the healthcare system and gain a more informed and active role in their healthcare decisions.
We brought these industry leaders together for a live forum to discuss how health insurers and providers can work together to improve the consumer experience, and how that can help healthcare consumers and the industry reduce costs, improve outcomes, and accelerate payment.
The panel: Bill Krause is vice president and general manager of Digital Experience and Consumer Engagement at Change Healthcare. Matt Eyles is president and CEO of America's Health Insurance Plans (AHIP). Joe Fifer is president and CEO of the Healthcare Financial Management Association (HFMA).
Here’s what the panel discussed and debated during the live forum:
- What consumers want from their digital healthcare experience
- How current digital tools fall short of consumer expectations
- Why health systems and insurers should work together to build better consumer experiences
- How providing consumers with information in advance helps reduce billing confusion after treatment
- Why telehealth is a good digital front door for providers
- Insights and ideas for empowering healthcare consumers to help drive healthcare transformation
Episode Resources
- Matt Eyles’ bio
- Joe Fifer’s bio
- Bill Krause’s bio
- AHIP website
- HFMA website
- Harris Poll 2020 Consumer Experience Index
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
How to Close the Trust Gap in Healthcare
To promote trust in artificial intelligence in healthcare, AI products and services must come from a deep understanding of user and patient needs and promote user and patient engagement.
By Keith Roberts
Keith Roberts is vice president of Engagement as a Service at Change Healthcare
Episode Resources
- Keith Roberts' bio
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Digital technology is making claims processing more efficient and cost effective—and that is changing how payers and providers collaborate, as well as their relationships. Today Phillip Cardona and Mike Peresie discuss how payers and providers are starting to use AI to analyze electronic medical record (EMR) data, increase claims processing automation, and streamline workflows, all with the potential to fundamentally transform the payer-provider relationship. They also cover the latest AI capabilities, what’s coming next, and how to prepare for the fundamental business shifts that AI can spark.
Phillip Cardona is strategy executive for Change Healthcare’s Payer Growth Program. Mike Peresie is senior vice president and GM of Medical Network at Change Healthcare.
Phil and Mike discuss:
- How AI's impact on claims processing can change payer-provider relationships
- Using AI to analyze EMR data to find revenue opportunities and cost savings
- “Intelligent transactions” and how they can improve efficiency
- The secret to eliminating paper shuffling, faxing, and snail-mailings in claims processing
- Why fixing front-end procedures helps speed back-end processes
- Enabling the remote workforce for today's new business environment
- Where AI and automation can help improve cash flow for both payers and providers
Episode Resources
- Phillip Cardona’s bio
- Mike Peresie’s bio
- Change Healthcare Payer Growth Program
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Groupers are key to developing alternative payment models, but not all groupers are alike
By Andrei Gonzales, M.D., assistant vice president, Value-Based Care Strategy, Change Healthcare
Dr. Gonzales is responsible for product management of HealthQx®, Change Healthcare’s value-based payments analytics platform.
Episode Resources
- Andrei Gonzales, M.D., bio
- Groupers Comparison Grid
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Up to 1 in 5 insured are covered by more than one healthcare plan. It’s no secret that one plan will often pay more claims than it’s obligated to while another never gets the bill. Health plans typically solve for this problem through provider audits and other post-payment activities, when better coordination of benefits (COB) up-front can prevent the improper payment altogether. But what does “better coordination” mean? Today Phillip Cardona and David Bachert reveal the secrets and impact of better COB.
Phillip Cardona is strategy executive for Change Healthcare’s Payer Growth Program. David Bachert is director of Payment Accuracy for Change Healthcare.
Here's what they covered:
- Why health plans pay should direct their attention to COB
- How coordination of benefits (COB) differ from third-party liability (TPL)
- Nuances of COB by state and plan type
- How plans can monitor for other primary coverage
- The trouble with “pay and chase” and payment recovery
- How to initiate a coordination of benefits program
- How to use available data to improve payment accuracy
Episode Resources
- Phillip Cardona’s bio
- David Bachert’s bio
- Change Healthcare Payer Growth Program
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Pandemic-Driven Medicaid and ACA Expansion Impacts and Considerations for Payers
By Jimmy Liu and Dan O’Brien
Jimmy Liu is vice president of Risk Analytics at Change Healthcare. Dan O’Brien is director for Risk Adjustment Strategy at Change Healthcare.
Understanding the full impact of the COVID-19 pandemic on the healthcare industry is not yet possible, but a few outcomes are evident. Medicaid and Affordable Care Act (ACA) enrollment rates are surging alongside the unemployment rate. In addition, postponed procedures and delayed routine services—as well as pent-up demand for elective procedures—will soon drive increased utilization.
This report details expected changes in the composition of national Medicaid and ACA member populations, and explores the potential financial consequences of the pandemic on payers. We address the timing of the Medicaid/ACA expansion and provide five immediate, actionable strategies to help payers mitigate challenges caused by the pandemic.
Episode Resources
- Jimmy Liu's bio
- Dan O’Brien's bio
- Pandemic-Driven Medicaid and ACA Expansion
- Risk Adjustment Analytics
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Ransomware attacks against hospitals are proliferating, in part because the attackers understand the consequences of compromising healthcare finances, patient privacy, and patient safety. With well over 60 known ransomware attacks against hospitals and health systems this year, healthcare leaders need to be thinking about what they can do to protect themselves better. On today’s show, Bob Hoover speaks with John Zuziak about the latest healthcare IT strategies that can help mitigate ransomware attack risk.
Today’s show panel features Bob Hoover, VP of Change Healthcare Consulting, and John Zuziak, practice director, IT Risk Management at Change Healthcare.
Here’s what they discussed:
- Why ransomware attacks targeting hospitals are increasing
- Reasons why hospitals are vulnerable to attack
- Hospitals and health systems that were attacked this year
- How ransomware compares with other cybersecurity threats
- How risk assessment differs for hospitals vs. other businesses
- How to quantify risk for executive leaders and board members
- The connection to COVID-19, remote work, and phishing attacks
- Strategies for preventing and mitigating against ransomware attacks
- When defenses fail: How to limit ransomware’s impact and recover quickly
Episode Resources
- Bob Hoover’s bio
- John Zuziak’s bio
- Change Healthcare Consulting
- Podcast: Cybersecurity During and After a Pandemic
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Healthcare's digital experience has lagged other industries. Then came the pandemic. Overnight, digital engagement became a safer way for consumers to find, access, and pay for medical care. Today’s panel looks at how better access to telehealth, and other recent advancements, convinced stakeholders how effective virtual healthcare delivery can be, and how that experience might foreshadow permanent market changes.
Today's panel features Change Healthcare's Natalie Lawrence, director of Business Development, and Zayan Khadri, product manager on the Digital Consumer Experience team.
Here are the issues they discussed:
- How the COVID-19 crisis pushed healthcare organizations to prioritize digital transformation
- The role of telehealth in the future of healthcare
- Why “touchless” experiences for processes such as patient check-in are now crucial
- Whether pandemic-induced virtual healthcare delivery will become permanent
- How healthcare organizations can make routine healthcare experiences resemble the best e-commerce experiences
- Sources of consumer dissatisfaction and how to address them
- The impact of the CMS price transparency mandate
- How to use the mandate as a competitive advantage
- What tomorrow's healthcare experience should look like
Episode Resources
- Natalie Lawrence’s bio
- Zayan Khadri’s bio
- Harris Poll 2020 Consumer Healthcare Experience Index
- Insights from the Harris Poll 2020 Consumer Healthcare Experience Research
- Shop Book and Pay
- Virtual Front Desk
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Healthcare interoperability gained increased urgency as a result of the pandemic. The need for public health measures, such as virtual care and contact tracing, showcased progress but also revealed gaps that must be closed. On today’s show, Arien Malec and Deanne Kasim speak with Paul Wilder, executive director of CommonWell Health Alliance, about how interoperability can drive innovation to close these gaps, mitigate compliance risks, and improve capabilities for stakeholders and the consumer experience.
Today's panel: Change Healthcare’s Arien Malec, SVP of R&D Deanne Kasim, executive director, Health Policy; and Paul L. Wilder, executive director of CommonWell Health Alliance.
Here's what they explored:
- The nationwide imperative for universal access to health data for patients, providers, and payers
- Data interoperability and access gaps that emerged during the pandemic
- How CommonWell's partnership with Carequality facilitates health data interoperability and portability
- How a federated system for record retrieval can operate without a central database
- Where gaps in the healthcare system persist
- The prospect of increased government regulation
- Anticipating regulatory requirements
- Where further regulation might be required to enable broad interoperability
Episode Resources
- Paul Wilder’s bio
- Arien Malec’s bio
- Deanne Kasim’s bio
- CommonWell Health Alliance
- Carequality Connectivity
- Change Healthcare Interoperability Solutions
- Change Healthcare Government Affairs
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Consumer expectations for a seamless digital health experience, coupled with healthcare's response to the COVID-19 pandemic, are accelerating the pace of the industry's digital transformation. On today's show, experts from Change Healthcare and Deloitte Consulting review the results of Deloitte research on COVID-19's impact on the healthcare consumer, along with Harris Poll research that reveals what today's consumer wants in a digital healthcare experience.
On today's show, Rick Preston moderates a discussion with panelists David Betts, principal for Life Sciences and Healthcare at Deloitte Consulting, and Bill Krause, vice president and general manager of Digital and Consumer Experience for Change Healthcare.
This show was produced as part of the Change Healthcare/Deloitte webinar series, The New Healthcare Essentials: Consumer Engagement, Interoperability, Virtual Care, and the Remote Workforce, which explores the four factors every healthcare organization must address to sustain and grow their business in the post-pandemic era.
The panel dives into:
- Key findings from Deloitte’s survey
- Research findings, surprises, and expected results
- The increase in consumer agency
- Stages of the healthcare journey where consumers are acting with greater agency
- How well the health system empowered consumers during COVID-19
- Healthcare decisions consumers feel confident in making
- When consumers feel they lack information to make good decisions
- Types of information missing from consumers’ decision making
- The healthcare experience consumers really want
- How healthcare measures up
- Important opportunities to improve the consumer experience
- Strategies to ease consumer access to healthcare
- What prevents change in consumer health behavior
- How payers can support members by providing a meaningful healthcare experience
- Viability of a concierge-like experience
- Role of the CMS price transparency rule in creating a better consumer experience
Episode Resources
- David Betts’ bio
- Bill Krause’s bio
- Deloitte Life Sciences & Healthcare
- Deloitte 2020 Survey of US Healthcare Consumers
- Change Healthcare - Harris Poll 2020 Consumer Experience Index
- Rebuilding Healthcare Consumer Confidence webinar replay
- Digital Patient Experience
- Communications and Payment Solutions for Payers
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
The election, the COVID-19 crisis, and a Supreme Court case challenging the Affordable Care Act have healthcare leaders on alert. What comes next? On today’s show, Change Healthcare’s Deanne Kasim and Angela Evatt take a look at the current policy landscape through the end of the year, and catch us up on what’s pending in Congress, with Washington regulators, and in the states; and how some of these issues might play out.
Today’s panel features Deanne Kasim, executive director, Health Policy, and Angela Evatt, senior manager, Health Policy, for Change Healthcare.
They run down:
- The stalled rescue package—and whether there will there be action in the lame duck session
- Legislation to enable greater flexibility for data exchange
- Whether temporary waivers allowing expanded use of telehealth will become permanent
- New regulations pending with OMB
- Status of the final CMS Price Transparency Rule for Payers
- Medicare Advantage developments and the possibility of new prior authorization rules
- Amy Coney Barrett’s Supreme Court nomination and the ACA
- What’s next for Congress
- State reopening and vaccine distribution plans
- State budgets and possible Medicaid budget cuts
- State data privacy and telehealth initiatives
- Elections and key races to watch
Episode Resources
- Deanne Kasim's bio
- Angela Evatt's bio
- State Actions to Close Budget Shortfalls in Response to COVID-19
- Telehealth Legislation & Regulation
- Change Healthcare Government Affairs
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
It’s no secret that achieving fully electronic prior authorization is a challenge, but the potential upside is tremendous—to the tune of $454 million in savings, according to the 2019 CAQH Index Report. On today’s show, Andrew Johnson meets with our special guest from CAQH, April Todd, to shed light on areas around prior authorization that remain the most challenging, the benefits of transitioning to an automated workflow, and efforts underway to speed adoption of electronic prior auth.
Today’s panelists are Andrew Johnson, vice president of Electronic Prior Authorization Solutions for Change Healthcare, and April Todd, senior vice president for the CAQH, a non-profit alliance creating shared initiatives to streamline the business of healthcare.
They unpack:
- The purpose and role of the CAQH CORE (Committee on Operating Rules for Information Exchange)
- Why prior authorization is a challenge for payers and providers
- Update on alignment between industry standards bodies, including CAQH, WEDI, and HL7 Da Vinci
- Which areas of healthcare are furthest along in adopting electronic prior authorization
- CAQH’s latest research on the cost of manual versus automated transactions
- How electronic prior authorization drives better patient care and reduces costs
- Building blocks of an ideal prior authorization workflow
- Steps Change Healthcare and CAQH are taking to advance electronic prior authorization
- How COVID-19 is affecting adoption
- Timeline for shifting prior authorization into a fully automated process
- How listeners can support electronic prior authorization advancement
Episode Resources
- April Todd’s bio
- Andrew Johnson’s bio
- CAQH website
- CAQH Index
- CAQH Core
- The "Intelligent" 278: Creating a Standard for Shared Decision Support
- InterQual Connect
- How InterQual Connect works
- Automation and Appropriate Care
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
The Protecting Access to Medicare Act (PAMA) requires providers to consult a clinical decision support mechanism when ordering advanced imaging tests. While the CMS has extended the PAMA compliance deadline to Jan. 1, 2022, some providers–such as St. Charles Health System–are wasting no time to ensure compliance. Samantha Waldrop and Elizabeth Zobel join Nick Geyer to share how St. Charles implemented imaging clinical decision support (CDS), including their goals, challenges encountered, their approach, and the results.
Nick Geyer, product marketing manager at Change Healthcare, leads a discussion with Samantha Waldrop, applications analyst at St. Charles Health System, and Elizabeth Zobel, senior customer success strategist at Change Healthcare.
Here what they talked about:
- Overview of PAMA
- Requirements around imaging Clinical Decision Support (CDS)
- Impact of PAMA on St. Charles
- How St. Charles evaluated imaging CDS options
- Why St. Charles decided to work with Change Healthcare
- How St. Charles defined implementation goals, plan, and timeline
- Team members involved
- How the rollout went
- Challenges encountered during the rollout and how St. Charles addressed them
- Impact of the new imaging CDS on providers and workflows
- Methods to drive CDS training and adoption
- Issues around providers using free text vs. structured indications
- Radiologists’ reaction to the new system
- CDS usage levels at St. Charles
- Next steps for St. Charles’ CDS roadmap
- Implementation lessons learned
- Advice for other healthcare providers on complying with PAMA and implementing imaging CDS
- Benefits of imaging CDS, beyond PAMA compliance
Episode Resources
- Samantha Waldrop’s bio
- Elizabeth Zobel’s bio
- Nick Geyer’s bio
- Your PAMA Questions Answered
- The New PAMA Math
- Laboratory Data Key to Overcoming Medicare Cuts
- Aligning the Lab with the Hospital’s Strategic Priorities
- Predicted Indications (AI) in CareSelect Imaging
- CareSelectTM Imaging
- CareSelectTM Imaging – AI Indication Selection
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Bronson Healthcare Group is about 18 months along in its transition of enterprise imaging to the cloud. With nearly two years of experience under its belt, Bronson’s Ken Buechele now has much to review and share with other healthcare IT leaders. Today Ken circles up with Tomer Levy to share Bronson’s cloud transition story, including why Bronson is making the shift, challenges and successes experienced along the way, where Bronson is taking its cloud journey next, and Ken’s strategic advice for IT leaders who are evaluating a transition.
Today’s episode features Tomer Levy, vice president of Global R&D and Enterprise Imaging for Change Healthcare, and Ken Buechele, vice president of Information Technology for Bronson Healthcare Group.
Topics they cover include:
- Where enterprise imaging sits within Bronson’s IT and patient engagement strategies
- Why Bronson is transitioning enterprise imaging to the cloud
- The current stage of Bronson’s transition
- Short- and long-term goals
- Metrics for success
- Benefits realized so far
- Challenges securing buy-in and how Bronson overcame them
- How a cloud-native approach meets security standards
- Advantages and drawbacks of adopting the cloud as a platform as a service (PaaS) versus software as a service (SaaS)
- Steps Bronson took to shift internal processes and organizational structure to transition to the cloud
- How Bronson balances three key priorities in the transition: reducing organizational complexity, managing spend, and delivering support for improving patient outcomes
- Which priorities will become more important as Bronson’s cloud journey evolves
- Advice for other IT leaders interested in embarking on a transition to the cloud
Episode Resources
- Ken Buechele’s bio
- Tomer Levy’s bio
- Enterprise Imaging
- Next Generation Enterprise Imaging: The Rise of Cloud Native Technology
- Enterprise Imaging resources
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Artificial intelligence (AI) is increasingly driving the next era of clinical decision support--but each successful use case spurs new questions about how AI should be used and where it belongs in clinician decision making. Today Andrea Keenan leads an important conversation with Laura Coughlin and Greg Magazu to discuss the role of AI in clinician decision making, and the challenges and opportunities it poses for providers and patients alike.
For Change Healthcare, Andrea Keenan is senior product manager of InterQual, Laura Coughlin is vice president of Clinical Information and Development of Decision Support, and Greg Magazu is senior product manager of InterQual AI solutions.
Here's what they covered:
- The emerging role of AI in clinical decision support and case management
- How to balance the value of AI with the value of the human experience
- How AI is influencing clinical decision support today
- Primary benefits of AI in clinical decision support
- AI's use in clinical decision support (CDS) and case management (CM) today
- What AI in CDS and CM will look like in 2025
- Common themes in successful AI use cases
- The path to AI’s benefits
Episode Resources
- Laura Coughlin’s bio
- Greg Magazu’s bio
- Andrea Keenan’s bio
- Leveraging Robotic Process Automation and AI in Utilization Management
- How Automation is Changing the Role of the case Manager
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Price transparency remains in the crosshairs for both providers and regulators. On today’s show Ann Gallagher and Corey Sturm review the latest news regarding the CMS’s Price Transparency Final Rule, and discuss what’s next for providers come the Jan. 1, 2021 compliance deadline. They cover lessons learned about implementing price transparency at the state level, and steps providers should be taking now to ensure compliance.
This episode features Change Healthcare’s Ann Gallagher, senior product manager of Patient Access, and Corey Sturm, product manager of Connected Consumer Health™ provider solutions.
They examine:
- The backstory on CMS’s Price Transparency Final Rule
- Where the regulation stands today
- Which states are already implementing price transparency rules
- Results of state efforts so far
- Whether early efforts have succeeded or struggled, and why
- States that might serve as models for other areas of the U.S.
- Steps providers need to take to meet the regulation by Jan. 1st
- Steps that are more challenging than others
- Pitfalls to avoid when ensuring compliance
- How the regulation can benefit providers
- How providers can use the regulation as a point of differentiation
- Recent Harris Poll research that documents why providers should embrace price transparency
Episode Resources
- Ann Gallagher’s bio
- Corey Sturm’s bio
- The 2020 Change Healthcare – Harris Poll Consumer Experience Index
- Change Healthcare - Harris Poll Research: Half of Consumers Avoid Seeking Care Because It’s Too Hard
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Technology is only half the battle when it comes to cybersecurity measures for healthcare organizations. The remainder is awareness. Phil Alexander joins John Zuziak on today’s show to dig into common gaps in security awareness and their implications. Phil and John examine the elements of a successful security awareness program, including how to gain buy-in; setting goals; identifying wins; communicating progress and successes; and ultimately making security awareness a part of the organization’s culture.
This conversation features John Zuziak, director of the Security and IT Risk Management Practice for Change Healthcare, and Phil Alexander, CISO for North Mississippi Health Services.
Here’s what they report on:
- The need to emphasize security awareness in healthcare
- Tailoring security awareness training by job function
- Topics to include in security awareness training
- Gamifying security awareness
- Making security awareness training work on a lean budget
- Building a security awareness program from scratch
- How to identify program goals
- Ideal KPIs for success
- How to win leadership buy-in for security awareness training
- Communicating program success
- Pitfalls to avoid
- Proof security awareness can succeed in healthcare
Episode Resources
- Phil Alexander’s bio
- John Zuziak’s bio
- SOC II + HITRUST: How These Audits Will Improve your Organization
- Vendor-Independent Healthcare Consulting
- Change Healthcare Consulting Services
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
EDI turns 55 this year. Unlike other information technologies from 1965, EDI continues to play a crucial role in healthcare. Few can speak to EDI’s history, continual evolution, and contemporary relevance like Sheryl Miller, executive vice president for Advanced Data Systems. On today’s show, Sheryl shares the surprising role of EDI as a backbone for the COVID-19 telemedicine surge, how her company uses EDI, why EDI’s use cases are growing, and more.
Today’s show is hosted by Serrah Linares, vice president of Partner Sales for Change Healthcare, and features Sheryl Miller, executive vice president for Advanced Data Systems.
Topics they cover:
- A brief history of EDI
- How EDI revolutionized healthcare IT, and why it continues to drive innovation
- Why EDI’s use cases evolved as a result of the pandemic
- EDI as a backbone for the COVID-19 telemedicine surge
- How COVID-19 is impacting healthcare revenue cycle management
- How ADS is using EDI to help providers address revenue cycle challenges
- How ADS uses EDI with Change Healthcare
- Predicting future use cases for EDI
Episode Resources
- Sheryl Miller's bio
- Serrah Linares's bio
- Advanced Data Systems Corp. (ADS)
- How To Prepare For Reopening Your Medical Practice After COVID-19
- How Telehealth Services Help Fight Against Coronavirus
- How the Mental Health Industry Has Been Impacted By COVID-19
- A Guide to Patient Satisfaction in the Age of Consumerism
- Accelerating Cash Flow and Business Office Efficiency
- Accurate Patient Registration Helps Healthcare System Drive Speed to Payment with Clean Claims
- Improving Self Pay Collections: One Proactive Approach
- Strategies To Successfully Manage Accident Claims
- API & Services Connection for Healthcare
- Medical Network Solutions
- Channel Partner Solutions
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Victories and challenges abound across U.S. states in their efforts to overcome the pandemic. We invited two special guests from the National Conference of State Legislators to provide a deep dive into the current and emerging state policy trends around Medicare, Medicaid, and telehealth. Haley Nicholson and Emily Blanford field key questions from Deanne Kasim and Arien Malec on the latest state actions, where legislative friction remains, and what’s next in state policy decision making.
Insights on this episode come from Deanne Kasim, executive director of Health Policy for Change Healthcare; Arien Malec, SVP of Research & Development for Change Healthcare; Haley Nicholson, senior policy director of Health & Human Services for the National Conference of State Legislators; and Emily Blanford, program principal for the National Conference of State Legislators.
Their deep dive covers:
- How states are preparing for the increase in demand for Medicare and Medicaid services
- Forecasts for Medicaid enrollment
- Tough budget decisions looming for states
- Funding differences between CARES Act and the Federal Medical Assistance Percentage (FMAP)
- How states have used these funds
- Update on federal public health funding availed to states for pandemic response
- Types of legislation and funding mechanisms that can augment state response
- States’ key emergency actions to support the telehealth surge
- Which actions should remain in place post-pandemic
- Technology challenges hampering telehealth’s growth, and how states are overcoming these issues
- Factors driving the payment parity debate between telehealth and in-person doctor visits
Episode Resources
- Emily Blanford’s bio
- Haley Nicholson’s bio
- Arien Malec’s bio
- Deanne Kasim’s bio
- National Conference of State Legislators
- Government Affairs
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Parkland Community Health Plan’s 2020 priority: transition to value-based healthcare. But a pandemic wasn’t in the plan. On today’s show, Bob Hoover talks with Parkland’s CEO John Wendling and consultant Joe McIntire to learn how, despite one of the most disruptive healthcare events in history, Parkland has been able to stay on track and meet its strategic goals. Their conversation reveals keys to collaboration and communication that enable the team to avoid delays, overcome complexities, and remain agile.
This episode features Bob Hoover, vice president of Change Healthcare consulting; John Wendling, CEO of Parkland Community Health Plan; and Joe McIntire, senior manager for Change Healthcare consulting.
Here's what they covered:
- Parkland’s goals to support patients
- Why Parkland is prioritizing these goals
- How COVID-19 influenced Parkland’s value-based care strategy
- Factors that drove Parkland to insource certain functions and change its business process outsourcing partner
- Mitigating COVID-19’s impact on project performance
- How Parkland anchors its services to its community
- Criteria Parkland uses to choose an HIT partner
- Overcoming remote access and work challenges
- How Parkland measures success
- Why Parkland’s transitions stands out among health plans
- How to enable a smooth transition for health plan transformation
Episode Resources
- John Wendling’s bio
- Joe McIntire’s bio
- Bob Hoover’s bio
- Parkland Community Health Plan
- Change Healthcare Consulting Services
- Preparing for a Core System Replacement
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Finding, accessing, and paying for healthcare requires so much work that half of consumers have avoided seeking care, according to the 2020 Change Healthcare - Harris Poll Consumer Experience Index, a national study of 1,945 consumers. These findings and more—many of which should cause serious concern for healthcare stakeholders—are covered on today’s show, with special guest Tom Swanson from Adobe. Also covered: what stakeholders can do to meet consumers’ expectations and gain a competitive edge.
Swanson joins show host Bill Krause to review the research, discuss what consumers say are the challenges to finding, obtaining, and paying for care, and unpack fresh digital strategies that can help providers give their patients exceptional experiences.
Bill Krause is VP and GM of Connected Consumer Health for Change Healthcare. Tom Swanson is head of Industry Strategy and Marketing for Health and Life Sciences at Adobe.
Here are the topics they tackled:
- Key findings from the research study
- Big surprises
- What healthcare can learn about consumer loyalty from other industries
- Steps to improve patient satisfaction and provider efficiency
- How to improve connectivity in the patient journey
- Ways to bring transparency to pricing
- The real meaning and importance of consumer centricity in healthcare
- Why unified data platforms are essential to improving the patient experience
Episode Resources
- Tom Swanson’s bio
- Bill Krause’s bio
- The 2020 Change Healthcare – Harris Poll Consumer Experience Index
- Change Healthcare - Harris Poll Research: Half of Consumers Avoid Seeking Care Because It’s Too Hard
- Patient Experience
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
When it comes to blockchain technology, most people have heard about crypto-currency and its application in finance. Less visible to the public are the advancements being made in other industries, from securing elections to tracing diamonds. Next up: Healthcare.
By Emily Bailey
Emily Bailey is product development director at Change Healthcare.
Episode Resources
- Emily Bailey's bio
- Blockchain Technology for Healthcare
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
No event in recent history demands telehealth like the coronavirus pandemic. Today’s episode features one of the country’s leading telehealth experts, Ann Mond Johnson, CEO of the American Telemedicine Association (ATA). G. Shah and Carolyn Wukitch join Ann for a lively discussion on one of the hottest topics in healthcare IT today: telehealth—including its evolving definition, applications, innovations, potential obstacles and public policies—and what it all means for payers, providers, and policymakers.
G Shah, VP of Healthcare Platform and Marketplace for Change Healthcare leads the conversation with Ann Mond Johnson, CEO for the American Telemedicine Association; and Carolyn Wukitch, SVP of Network and Financial Management Solutions for Change Healthcare.
They cover:
- How COVID-19 is changing the definition of telehealth
- Whether the new face of telehealth is here to stay
- Tips for providers and payers when adopting telehealth services
- Ways to scale telehealth services
- How payers and providers should coordinate telehealth strategies
- Estimations on whether non-clinical telehealth applications will take root
- Impact of expanded applications on rural and underserved communities
- Telehealth’s potential to flatten the curve in areas deprived of primary care providers
- Update on the latest telehealth policy and regulatory changes
- What progress is needed to mature telehealth policies
- How payers can support telehealth expansion
- Forecasts for the future of telehealth
Episode Resources
- Ann Mond Johnson’s bio
- Carolyn Wukitch's bio
- G Shah’s bio
- Managing Risk Adjustment in Light of the Pandemic: Focus on Telehealth
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Avoiding Common Financial Pitfalls While Seizing RCM Improvement Opportunities
Onboarding an electronic health record (EHR) is one of the most complex and disruptive implementations a healthcare organization can undertake. This type of initiative impacts, and in many cases, fundamentally changes every aspect of your clinical and financial operations. Given the size and scope of these projects, it’s not surprising that the revenue cycle implications are vast, and an unsuccessful implementation can pose significant financial risks to your organization.
By Elaine Dunn
Elaine Dunn is vice president of Revenue Integrity and Centralized Coding at Change Healthcare.
Episode Resources
- Elaine Dunn's bio
- Building a Culture of Revenue Integrity
- Strategies for Fine-Tuning Revenue Integrity
- Revenue integrity Solutions
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
It’s evident to Dr. David Shulkin that the path to safely reopening businesses is not exclusively guided by local, state, and national government. Employers, together with government and health systems, play pivotal roles. On today’s show, Deanne Kasim joins Arien Malec to lead a compelling discussion with Dr. Shulkin, the 9th Secretary of the Department of Veterans Affairs. Dr. Shulkin draws on his deep experience in the public and private sectors to provide advice for employers working on their reopening plans.
Today’s episode features Deanne Kasim, Executive Director of Health Policy for Change Healthcare; Dr. David Shulkin, the Ninth Secretary of the US Department of Veterans Affairs, and Arien Malec, SVP of Research & Development for Change Healthcare.
They dissect:
- Lessons the U.S. has learned about managing COVID-19
- Challenges health systems must still address
- How employers can work with government and public health authorities to reopen businesses safely
- Predictions for the state of work over the next year
- Lasting changes in employment safety and workplace design
- Ways employers can prepare for future health emergencies
- How USHealthyWork is supporting employers
- How employers can navigate reopening offices across states with varying safety recommendations
- Why government, employers, and health systems must collaborate on a national strategy for reopening
Episode Resources
- Dr. David Shulkin’s bio
- Arien Malec’s bio
- Deanne Kasim’s bio
- USHealthyWork
- Change Healthcare Government Affairs
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Revenue cycle management (RCM) is a rapidly changing, multi-billion dollar market with a complex set of challenges. Care delivery organizations are starting to realize that the way they’ve traditionally managed the revenue cycle will not work going forward. New and emerging dynamics are fundamentally altering how healthcare is delivered and paid for. To navigate these shifting undercurrents, organizations must appreciate the factors driving change and develop innovative strategies to create a new paradigm.
By Thomas Laur
Thomas Laur is executive vice president of Change Healthcare and president of Technology Enabled Services.
Episode Resources
- Thomas Laur’s bio
- Artificial Intelligence Equals Real Transformation for Revenue Cycle Management
- Revenue Optimization Resource Library
- Revenue Cycle Optimization Webinar Series for Hospitals and Health Systems
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Gone is the traditional understanding of capacity management. On today's how, Terri Epler connects with Duncan Campbell to give us an insider's view of how COVID-19 upended the healthcare industry’s historical view of capacity management. They dissect how COVID-19 impacted hospital capacity, and examine why capacity management is crucial for efficient operations during every level of patient demand.
Terri Epler, RN, MSN, product consultant for Change Healthcare, leads the conversation with special guest Duncan Campbell, principal of Craigavon Enterprises. Duncan spearheaded several healthcare turnaround and performance improvement initiatives throughout Canada, and is the former CFO of Vancouver Coastal Health.
Their conversation pulls back the curtain on:
- Capacity challenges providers face daily
- Initial and ongoing impact of COVID-19 on patient flow and hospital capacity in the U.S. and Canada
- How and why capacity management broke down when the pandemic started
- Ways in which providers coped
- What approaches worked and failed, and why
- Lessons providers learned to guide better capacity management
- Why capacity management is crucial at every level of demand
- The role of IT to help manage capacity
- How Change Healthcare customers are navigating capacity management today
- Factors that create urgency to forecast capacity highs and lows
- Benefits of accurately aligning demand to resources
Epsiode Resources
- Terri Epler’s bio
- Duncan Campbell’s bio
- Hospital Capacity Management Solutions
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
With the rise of healthcare consumerism, people are looking to hospitals, health systems, and physician practices to deliver the same user-friendly, digital experiences they receive from other industries.
People want to easily make appointments, understand what their financial outlays will be, make payments, and set up payment plans if the estimated costs exceed their budgets—all via their mobile devices or tablets. Unfortunately, most healthcare organizations aren’t ready to provide this level of convenience. In part, this is because they have relied on patient portals as their main digital engagement tools to date.
By Bill Krause
Bill Krause is vice president and general manager of Digital Experience and Consumer Engagement for Change Healthcare.
Episode Resources
- Bill Krause's bio
- Change Healthcare - Harris Poll Research: Half of Consumers Avoid Seeking Care Because It’s Too Hard
- The Change Healthcare - Harris Poll 2020 Consumer Experience Index Report
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Medicaid and Medicare are seeing major changes in federal and state policies amid the global health emergency. Today’s panelists dive into new guidance for state Medicaid agencies, how COVID-19 affects those who are dual-eligible for Medicaid and Medicare, and how these changes impact health plans.
Stream now to hear from Angela Evatt, senior manager of State Healthcare Policy; Eric McAllister, Government Affairs specialist; Lisette Montesinos, manager of Government Relations; and Chad Wege, vice president of Program Management, all with Change Healthcare.
They dive into:
- The scope of federal assistance supporting state Medicaid agencies
- Criteria for states to obtain federal assistance
- State and federal guidance surrounding recertification of Medicaid beneficiaries
- COVID-19’s impact on people who are dual-eligible for Medicaid and Medicare
- Variance in COVID-19 response at the state level
- How state Medicaid agencies are adapting their policies in the COVID-19 era
- Steps Change Healthcare is taking to support health plans amid evolving COVID-19 challenges
- New ways health plans can support members
- Future impact of COVID-19 on health plans
Episode Resources
- Angela Evatt’s bio
- Chad Wege’s bio
- Lisette Montesinos’ bio
- CMS's COVID-19 FAQ
- How to Renew Dual Eligibles for Medicaid
- How to Optimize Dual Enrollments
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Stories of hospital lab early adopters that have successfully implemented third-party decision support
Current events highlight the critical role of the hospital laboratory as the primary source of diagnostic information. But legislation such as PAMA (Protecting Access to Medicare Act) can potentially reduce lab reimbursements when clinical decision support is not used to ensure appropriate care.
This audiobook provides front-line perspective and commentary from experts and physicians at Mayo Clinic Laboratory on the application of clinical decision support technology in the lab. It also includes data from early adopters in hospital laboratories that have successfully implemented third-party decision support to achieve their stewardship goals, including electronic health record (EHR) interventions, and ongoing monitoring of utilization.
By Ben Gold and Curtis Hanson, M.D.
Ben Gold leads CareSelect product strategy for Change Healthcare, to help providers transition to value-based care. Previously, he worked for Epic Systems managing enterprise EMR implementations for U.S. academic medical centers.
Curtis Hanson, M.D., is Professor of Laboratory Medicine and Pathology, Consultant in Hematopathology, Executive Physician for Healthcare Innovation, at Mayo Clinic Laboratories. He previously served as chair of the Department of Laboratory Medicine and Pathology, and is currently the executive physician for Healthcare Innovation at Mayo Clinic Laboratories. Hanson leads the government relation activities for Mayo Clinic Laboratories, and is the past chair of the board of directors for the American Clinical Laboratory Association.
Episode Resources
- Ben Gold's bio
- Dr. Curtis Hanson's bio
- Mayo Clinic
- CareSelect Lab
- Align Lab and the Hospital’s Strategic Priorities
- Reality Check: Buy Versus Build for Laboratory Decision Support
- Clinical Laboratories at a Crossroads
- Change Healthcare announces CareSelect Imaging Open Access
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
As health system consolidation continues, cardiology HIT vendors are working to resolve interoperability and scalability challenges. With the influx of complex procedures and additional data points, clinical users are finding it more difficult to focus on their core mission: delivering excellent patient care.
On today’s show, Jessica Smith talks with Ori Garini, director of Product Management at Change Healthcare, about ongoing challenges within cardiology, how redundant data entry distracts from patient care, and the importance of anchoring system design to usability requirements.
Here’s what they covered:
- How interoperability challenges complicate a workflow
- Deriving actionable insights from cardiovascular workload data
- Reducing TCO as facilities consolidate cardiovascular systems
- The impact of confusing data entry requirements on clinician productivity
- Limits of departmental best practices on workflow optimization
- Technical advantages of a single database and single point of connectivity
- EMR interoperability as a guideline for cardiovascular product development
- How system design and infrastructure can drive operational efficiencies
- Querying structured data during the daily procedural workflow
- Benchmarking turnaround time data to isolate root causes of underperformance
- Using analytics to pinpoint inefficiencies and close gaps
- Anticipating emerging needs with an agile roadmap
Episode Resources
- Ori Garini’s bio
- Jessica Smith’s bio
- Enterprise Imaging Strategy
- Enterprise Imaging Cloud Strategy
- Change Healthcare Cardiology™
- Enterprise Medical Imaging Solutions
- Enterprise Imaging Community
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Responding to security and privacy challenges in the age of COVID-19 is a tall order—and it’s even more complicated if you’re just starting a new role as a chief information security officer (CISO). Meet Steven Ramirez, who became Chief Information Security Officer for University of Louisville Health in January. He met with John Zuziak to share his story of a COVID-era indoctrination by fire, discuss the changing risk management landscape, and reflect on cybersecurity issues facing every healthcare CISO.
Today's panelists are John Zuziak, Cyber Security Practice Director for Change Healthcare Consulting; and Steve Ramirez, CISO for University of Louisville Health.
They discuss:
- The career track that led to a CISO role
- Balancing regulation, cyber threats, and patient safety
- How COVID-19 changed Steve’s 90-day plan
- Ways to use resources, including existing security assessments, to define initial goals
- The pandemic's impact on the University of Louisville Health’s IT security
- New trends in threats and attacks targeted at remote employees
- Steps to drive a secure transition to a virtual workforce
- Using IT to speed employee onboarding when in-person engagement is not an option
- Goals to guide a CISO during a pandemic
- The secret sauce for communicating risks and incidents in the boardroom
Episode Resources
- John Zuziak’s bio
- Steven Ramirez’s bio
- The Essential Role of a Chief Information Security Officer
- How to Mitigate Risks with Virtual CISO Services
- Healthcare Consulting Services
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Is the COVID-19 pandemic a wake-up call for value-based payment innovation and care delivery, or does it raise serious questions about value-based models’ ability to perform? Host Mark Moticik circles up with David Delaney, Cindy Garvin, and Andrei Gonzalez to explore the immediate and lasting impact of COVID-19 on value-based care, and review the steps payers can take to understand how alternative payment and care models performed throughout the crisis.
Today’s expert panel convened Mark Moticik, vice president of Payer BPaaS Services at Change Healthcare; David Delaney, MD, senior vice president and general manager of Payer Technology Enabled Services at Change Healthcare; Cindy Garvin, senior consulting manager at Change Healthcare; and Andrei Gonzalez, associate vice president, Product Management, Value-Based Payments at Change Healthcare.
Listen in for the panel’s insights on:
- How COVID-19 is influencing momentum around value-based care
- Whether the pandemic can accelerate the case for value-based care
- Potential changes to the relationship between primary care physicians and specialists
- New provider and payer perspectives on risk, capitation, and other alternative payment models
- Which innovations in care, such as telemedicine and drive-thru testing, will persist beyond the COVID-19 crisis
- How these innovations can impact the value equation long term
- Ways to create a more elastic healthcare system in the U.S.
- Why the healthcare industry’s experience fighting COVID-19 could change the definition of value-based care
- Predictions on how COVID-19 will impact the underlying economic model of care delivery
- Whether alternative payment models can co-exist with government-sponsored plans
- Latest lessons learned about social determinants of health (SDoH) beyond testing, treatments, and fatalities
- Steps payers can take to implement and sustain SDoH strategies
Episode Resources
- David Delaney’s bio
- Andrei Gonzalez’s bio
- Cindy Garvin’s bio
- Mark Moticik’s bio
- CMS COVID-19 FAQ
- Medicaid COVID-19 Portal
- Case Study: Value-Based Care Enablement
- Best Practices to Engage Providers in Value-Based Models
- How to Accelerate the Transition to Value through Episode Intelligence
- Value-Based Payments Resource Center
- HealthQx Value-Based Payment Analytics
- Value-Based Care Business Process Management Services
- Value-Based Care Enablement Solutions
- Value-Based Care Transformation Services
- Value-Based Payment Solutions
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Organizations that don’t have strong revenue integrity leave money on the table and might experience compliance problems
If you ask 10 revenue cycle leaders what the primary focus of their revenue integrity efforts should be, you might get 10 different answers. Revenue integrity is not confined to one part of the revenue cycle, and it is not a stand-alone function. In the truest sense, revenue integrity is an outcome.
By Elaine Dunn and Vindali Vartak
Elaine Dunn is vice president of Revenue Integrity at Change Healthcare. Vindali Vartak is senior director of Advanced Analytics at Change Healthcare.
Episode Resources
- Elaine Dunn's bio
- Vindali Vartak's bio
- Strategies for Fine-Tuning Revenue Integrity
- Revenue Integrity Solutions
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
The pandemic left payers, providers, and regulators no choice but to fully embrace telehealth--finally. CMS, ONC, and payers expanded coverage. Providers flocked to telehealth to mitigate the risk of in-person visits and ensure care delivery. In the aftermath, the benefits and limitations of “telehealth,” and the promise of a true virtual care model, are now clear—as are the gaps that must be closed, such as enabling labs, e-prescriptions, remote imaging, expanded eligibility, claims management, and more.
On today’s show, G. Shah, VP of Platform and Marketplace, convenes a Change Healthcare expert panel to discuss how COVID-19 upended the telehealth trend, the trajectory of telehealth’s evolution into a true virtual care model, and what’s needed from a business and technology standpoint to get there. On the panel: Ian Ellis, VP and general manager of Clinical Exchange; Cindy Klain, VP of Medical Network; and Greg Jones, director of Product Management.
Here’s the deep dive they took into the present and future of virtual care:
- Expanding the footprint of care
- Patients seeing remote providers: How do they get their labs and prescriptions?
- How payers and providers can get started with telehealth
- Digital health companies and innovation
- Using APIs to build better solutions
- Ensure providers are equally supported in the telehealth model
- From telehealth to true virtual care: the next vista
- The bookends of the financial journey for telehealth providers
- The financial model of providing care
- Virtual labs and prescriptions
- Virtual imaging
- Virtual medical eligibility and claims management
- Using bundled APIs to help telehealth providers create better experiences
- Towards continuous care from an episodic care model
- Eliminating complexity
- APIs only a telehealth provider could love
- This time next year: What does virtual care success look like?
Episode Resources
- G. Shah’s bio
- Ian Ellis’s bio
- Cindy Klain’s bio
- Greg Jones’ bio
- Change Healthcare Launches Suite of Solutions to Support and Accelerate the Adoption of Virtual Care
- Telehealth Medical Eligibility and Claims Management API Bundle
- Telehealth Lab Orders, Results, and ePrescribe API Bundle
- Virtual Care Enablement
- API & Services Connection™ for Healthcare
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Interoperability improves patient outcomes, lowers cost, and can serve to meet evolving regulatory standards
Value-based care—and the regulatory push for transparency—expands the need for collaboration. Increasingly, that interoperability will expand from provider-to-provider systems to include patients and payers.
By Faisal Mushtaq
Faisal Mushtaq is SVP and General Manager of Clinical Networks at Change Healthcare.
Episode Resources
- Faisal Mushtaq's bio
- Change Healthcare Offers Free Connected Consumer Health™ Interoperability Solution for Health Plans to Meet CMS Deadline
- Change Healthcare Launches Suite of Solutions to Support and Accelerate the Adoption of Virtual Care
- Accelerate Healthcare Data Interoperability
- Interoperability Solutions for Healthcare
- Advancing the Use of APIs in Healthcare
- API & Services Connection™ for Healthcare
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Cybersecurity is only as strong as the security of an organization's vendors. Randall Frietzsche, chief information security officer (CISO) of Denver Health, a level one trauma center in Denver, has his organization's information security assessments down to a science. On today’s show, Randall joins Change Healthcare’s John Zuziak to share how Denver Health conducts security assessments, and how Randall's team assesses new vendors and monitors for vulnerabilities.
Today's panel: John Zuziak, Change Healthcare's Security and IT Risk Management Practice director; and Randall “Fritz” Frietzsche, MS, CISSP, CHPC, C|EH, C|HFI, ISSA distinguished fellow, and enterprise chief information security officer (CISO) at Denver Health, Denver, Colo.
Here’s what they talked about:
- Frameworks for building security programs and assessments
- Assessing security risk with third-party vendors
- Creating a risk management policy
- Conducting risk stratification analysis
- Assigning risk tiers to third-party vendors
- Keeping an eye on control gaps
- Bucketing risks: financial, reputational, patient safety
- Addressing vendors’ security gaps
- Allowing for exceptions to the rules
- The security check as part of the purchasing workflow
- Top 10 security control objectives in every contract
- The annual third-party review
Episode Resources
- Randall Frietzsche’s bio
- John Zuziak's bio
- Denver Health
- Change Healthcare Consulting Services
- Change Healthcare Consulting Services Resources
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Welcome to the Capitol Connection, a quarterly update on what's happening on Capitol Hill and in various state legislatures around healthcare policy. Our special guest today is Mary Grealy, President of the Healthcare Leadership Council. The HLC is a coalition of chief executives from all disciplines in U.S. healthcare. It’s the exclusive forum for healthcare leaders to develop policies, plans, and programs to achieve a 21st century system that makes affordable, quality care accessible to all Americans.
Your hosts for today’s show are Deanne Kasim, Executive Director of Health Policy at Change Healthcare, and Angela Evatt, Senior Manager of State Policy Strategy at Change Healthcare.
Here's what the panel included in this quarter’s Capitol Connection:
- Background on the HLC
- The latest information on federal and state policies in response to COVID-19
- The next relief package: thoughts and priorities
- What’s next for Congress this summer
- Will states’ relaxed telehealth requirements last?
- Ensuring appropriate use of telehealth
- Update on the HLC’s Disaster Preparedness Task Force
- How policy has shifted due to and during the pandemic
- Pondering COVID-19’s impact on upcoming elections
- How election campaigns are changing due to the pandemic
- Changes to anticipate on policy issues of focus by candidates
- How a second viral wave might change the policy landscape
Episode Resources
- Mary Grealy’s bio
- Deanne Kasim's bio
- Angela Evatt's bio
- Healthcare Leadership Council
- A National COVID-19 Surveillance System: Achieving Containment
- Change Healthcare Government Affairs
- Change Healthcare Industry Insights
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
- Change Healthcare Insights Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
The American College of Healthcare Executives (ACHE) has been advancing leaders and healthcare management excellence for 85 years. We invited ACHE President and CEO Deborah Bowen, FACHE, and Carrie Owen Plietz, FACHE, ACHE Chairman-Elect, EVP and COO, WellStar Health System, to give us their advice for how leaders can respond effectively to patient, community, and business concerns around the pandemic, from the standpoint of the industry’s preeminent professional society.
Today’s panel:
Host: Navesh Kandiyil, MD, MBA, FACHE, Change Healthcare
Guests: Deborah Bowen, FACHE, CAE, president and CEO of the ACHE; and Carrie Owen Plietz, FACHE, EVP and COO, WellStar Health System, and ACHE Chairman-Elect
Here’s how the conversation went.
- ACHE backgrounder
- Inside the hot spots
- Lessons providers are learning from inside the hot spots
- Inside the cold spots
- What’s working, what’s not
- How ACHE is responding
- The impact on payer-provider collaboration
- Six priorities for providers facing the crisis
- Unexpected provider innovations
- Short- and long-term impacts on healthcare leadership
- How do we ensure healthcare is delivered in a safe environment?
- How priorities will shift post-pandemic
Episode Resources
- Deborah Bowen’s bio
- Carrie Owen Plietz’s bio
- Navesh Kandiyil’s bio
- The American College of Healthcare Executives
- Become a FACHE
- ACHE COVID-19 Resource Center
- Hospital Revenue Cycle Services
- End-to-End Advanced Revenue Cycle Management
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Today’s show is an update on policy proposals to help improve the pandemic’s outcomes and reopen the U.S. economy.
Today’s panel is led by Deanne Kasim, executive director of Health Policy at Change Healthcare; and Arien Malec, SVP of product R&D at Change Healthcare, former ONC leader, and current HITAC member.
Here's what they covered:
- Proposals to reopen the economy
- Where we’re at today
- What’s changed since April
- What to consider and focus on
- A roadmap to reopen the recovery and beyond
- Policy, proposals, and infrastructure
- The phenomenon of the wizard’s apprentice
- Contact tracing technologies and implications
- Contact tracing security, privacy, and data rights
- Thoughts on digital immunity passports
- Scaling vaccine production and distribution, treatment cost, and reimbursement
- Playbook for the next pandemic
Episode Resources
- Arien Malec’s bio
- Deanne Kasim’s bio
- Reopening the Economy: How Fast is Too Fast?
- Change Healthcare Government Affairs
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
How Change Healthcare’s API and Services Connection™ marketplace helps payers, providers, and digital health companies deliver a more efficient, consistent experience
Learn how APIs sourced from a portfolio of integrations, workflow enablers, and intelligent advisors let payers, providers, and digital health companies create innovative ways to engage, care for, and manage patients.
By Gautam M. Shah
G. Shah is Vice President of Platform and Marketplace, Change Healthcare.
Episode Resources
- G. Shah's bio
- Enabling Efficiency in Telehealth
- Advancing the Use of APIs in Healthcare
- API & Services Connection™ for Healthcare
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
The pandemic tipped telehealth from a disruptive technology into the mainstream, according to the AMA. We invited John Jesser, President of Clinical Solutions at Amwell, to tell us what the surge in telehealth looks like from the vantage point of a global telehealth leader; the implications for consumers, providers, payers, and digital health innovators; technical, operational, and regulatory barriers that remain; and what telehealth might look like and how it might change after the pandemic.
Joining Amwell’s Jesser is Jonathan Parks, VP of Business Development at Change Healthcare. Here’s what they discussed.
- Was the telehealth industry prepared for the pandemic?
- Positives, negatives, lessons learned by telehealth providers
- How well are telehealth vendors, health systems, employer groups, and health plans working together?
- A telehealth entry point for hospitals and health systems
- Opportunities to make telehealth a more seamless, omnichannel experience for patients
- Telehealth issues for employer groups: returning to work, on-site clinics, monitoring/testing in place
- Working with health plans
- How health plans are adapting
- How the telehealth shift is affecting business models at health plans
- Telehealth’s legal, regulatory, and administrative impact
- Guidance for health plans’ telehealth strategies
- Expanding telehealth beyond the current catalog of services, technical, and legal limitations
- Will telehealth ever transcend the office visit?
Episode Resources
- John Jesser's bio
- Jonathan Parks' bio
- Amwell
- Coronavirus: How Telehealth Can Help
- AMA: COVID-19 Makes Telemedicine Mainstream
- Enabling Efficiency in Telehealth
- Advancing the Use of APIs in Healthcare
- API & Services Connection™ for Healthcare
- Medical Network Solutions
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
The CMS’s Interoperability and Patient Access rule, finalized in March, requires payers give members easy access to, and control over, their claims data. As payers face this looming deadline, they have a choice: comply with the basic requirement, or use the mandate as catalyst to modernize member engagement and improve their market advantage. On today’s show, Deanne Kasim, Bob Hoover, Ed Hafner, and German Scipioni discuss the CMS mandate and opportunities for payers to capitalize on it.
The Change Healthcare podcast panel: Deanne Kasim, Executive Director of Health Policy Bob Hoover, VP of Consulting Ed Hafner, AVP of Payer Strategy Medical Network German Scipioni, VP of Product Consumer Services
Here’s the path they took for today’s discussion:
- Quick recap: Intent and requirements of the Rule
- Assessing technical capabilities
- Data governance requirements
- What APIs must give payers and members
- A strategy for achieving a new level of member engagement
- Preparing for responses from informed patients
- How to execute your strategy to meet the deadline
- Models for interoperable member-facing solutions
Episode Resources
- Bob Hoover's bio
- Deanne Kasim's bio
- Ed Hafner's bio
- German Scipioni's bio
- CMS Interoperability and Patient Access Final Rule
- CMS Interoperability and Patient Access Fact Sheet
- Change Healthcare Offers Free Connected Consumer Health™ Interoperability Solution for Health Plans to Meet CMS Deadline
- Change Healthcare Consulting Services Resource Hub
- Change Healthcare Consulting Services
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
As CEO of the Healthcare Financial Management Association, Joe Fifer sits at the epicenter of COVID-19’s financial impact on providers. Many of the HFMA’s 56,000 members were hit hard by the pandemic, and the HFMA has been working overtime to support them through the crisis. On today’s show, Fifer joins Change Healthcare EVP Thomas Laur for a C-suite discussion on the unprecedented challenges revenue cycle professionals now face, how providers are coping, and what can be done to help foster a faster recovery.
They discussed:
- COVID-19’s one-two punch
- How HFMA members are taking on their top priorities
- A bright spot among the financial damage
- Will telehealth change workflows forever?
- How and when providers can get back to the office
- HFMA’s guidance to members
- HFMA’s financial outlook on U.S. healthcare
- Unemployment’s implications for healthcare
- The rapid increase of self-pay
- What the new normal will look like
- The indelible mark of digital health
- New roles for AI and automation
- The nexus of innovation and compassion
Episode Resources
- Joseph Fifer’s bio
- Thomas Laur’s bio
- How to Manage Revenue Cycle and Operational Stability Throughout a Healthcare Crisis
- HFMA/AHIP Joint Billing Guidance
- HFMA Recommended Coronavirus Resources
- HFMA Industry Initiatives: Healthcare Dollars & Sense
- HFMA’s Consumerism Maturity Model
- Strategies for Managing Cost, Patient-Access Operations, and Revenue During a Crisis
- End-to-End Advanced Revenue Cycle Management
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Patient Collection Strategies in an Economic Downturn
Today many healthcare organizations are facing new levels of uncertainty as a result of the COVID-19 pandemic. While each organization is focused on caring for patients and keeping team members safe and healthy, providers cannot help but also be concerned about the impact this will have on other areas. This rapidly evolving pandemic has put pressure on all facets of healthcare, including clinical care, the revenue cycle, and personnel management.
With that said, it is imperative for providers to evaluate their communications and outreach programs to help ensure that all print, digital, and voice communications have a compassionate, empathetic, and respectful tone that acknowledges the patient’s new and often stressful situation. There are several steps providers can take now, and over the coming months, to help increase patient-collection outcomes and lower overall revenue risk.
By David Figueredo
David Figueredo is National Vice President of Sales, Technology Enabled Sales at Change Healthcare.
Episode Resources
- David Figueredo's bio
- Technology-Enabled Services
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
From his vantage point as CEO of America’s Health Insurance Plans (AHIP), Matt Eyles has a unique perspective on myriad challenges payers, their members, and their provider networks face during the COVID-19 pandemic; and what our post-pandemic future might look like. In this episode, Carolyn Wukitch, SVP and GM of Network and Financial Management at Change Healthcare, talks with Eyles about these topics and more, including:
- Challenges health plans face during the pandemic
- Engaging members with underlying health issues
- Acceleration of telehealth––today and tomorrow
- Planning for 2021 amid immense uncertainty
- Supporting providers on the front line
- Helping the newly unemployed
- Removing cost barriers to treatment
- The impact of Medicaid member increase
- COVID-19's impact on provider networks
- COVID-19 testing and reopening the economy
Episode Resources
- Matt Eyles' bio
- Carolyn Wukitch's bio
- AHIP website
- AHIP COVID-19 FAQ
- AHIP COVID-19 Resources
- AHIP 2020 Institute & Expo Online
- Change Healthcare Offers Free Connected Consumer Health™ Interoperability Solution for Health Plans to Meet CMS Deadline
- Solutions for Payers
- Consumer Payments & Communication Services
- Eligibility & Enrollment Solutions
- Healthcare Consulting Services
- Payment Accuracy Solutions
- Provider Network Optimization Solutions
- Risk Adjustment Analytics Solutions
- Value-Based Care Enablement Solutions
- Value-Based Payment Solutions
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Tougher requirements are coming for D-SNP, the dual-eligible special needs program for Medicare and Medicaid. On today’s show, Shelley Stevenson and Phillip Cardona discuss upcoming regulatory changes, what payers need to know to ensure compliance, and opportunities that arise for payers and members.
Shelley Stevenson leads the government programs practice at Change Healthcare Consulting. Phillip Cardona is a strategy executive with Change Healthcare’s Payer Growth Program. Here’s what they chatted about.
- D-SNP and eligibility
- States starting to require D-SNP plans
- Tougher requirements coming in 2021
- Timeline and roadmap for preparing for 2021 regulations
- How the new regulations impact providers
- What payers need to do to keep providers informed
- Mobilizing a clinical team
- Siloed Medicare and Medicaid patients and the shift to integrated plans
- The impact on long-term support services
- How to analyze where members will need support
- Moving to holistic care
Episode Resources
- Shelley Stevenson’s bio
- Phillip Cardona’s bio
- How to Modernize Dual Enrollment with AI and Behavioral Science
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Government officials are weighing testing, tracing, and isolating the public while pondering how and when to restart the economy. As a former ONC leader and current HITAC member, Change Healthcare's SVP of product R&D Arien Malec is watching the COVID-19 policy proposals currently in play.
On today's episode, Arien is joined by Deanne Kasim, executive director of Health Policy at Change Healthcare, for a wide-ranging discussion of COVID-19 testing and surveillance policy proposals. Here’s what they hit upon.
- What American healthcare needs to accommodate effective COVID-19 surveillance
- Takeaways from the Duke-Margolis report on a national surveillance system
- Proposals for getting people back to work during COVID-19
- Social distancing and lockdowns while waiting for a vaccine
- Proposed strategies and global practices for controlling the spread of disease while reopening the economy
Episode Resources
- Arien Malec’s bio
- Deanne Kasim’s bio
- A New Strategy for Bringing People Back to Work During COVID-19
- A National COVID-19 Surveillance System: Achieving Containment
- Data Interoperability and Exchange to Support COVID-19 Containment
- Change Healthcare Government Affairs
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Few people are better situated to help us understand the tangled web of issues facing providers today than Becker’s Hospital Review Editor-in-Chief Molly Gamble. Beyond the capacity and supply problems triggered by the pandemic, hospitals and health systems are peering over the edge at some very real existential threats.
On this episode, Kelley Blair, senior vice president and GM of Health System Services at Change Healthcare, connected with Gamble to talk about what she has seen, experienced, and reported for Becker's Healthcare readers over the past six weeks. Topics that they hit on:
- Takeaways from conversations with providers in the 10 hardest-hit states
- Novel challenges facing the healthcare system as it moves into recovery
- New ways in which health systems are communicating with patient populations
- How payers can support providers during the pandemic
- Managing solvency in the face of declining patient volumes
- The role of data in helping hospitals assess the impact of COVID-19
- Potential long-term impacts of the pandemic
Episode Resources
- Molly Gamble’s bio
- Kelley Blair’s bio
- Becker’s Hospital Review
- Becker's Latest COVID-19 Coverage
- Becker's Healthcare Upcoming Conferences
- Healthcare Provider Solutions
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
COVID-19 lockdowns and the social isolation they can cause can have an outsized impact on the health of senior citizens and other vulnerable populations. Indeed, several studies associate social isolation and loneliness with increased mortality that's comparable to smoking 15 cigarettes a day.
Today's show features a conversation with Jeff Barkin, MD, associate medical director; Victoria Pham, DO, medical director, Clinical Development, Strategy, and Client Experience; Monique Yohanan, MD, MPH, senior medical director, Level of Care team, and director for Content Development; and Kelly Cavin, VP of Social Determinants of Health, all with Change Healthcare.
Our expert panel discusses what providers and health plans are doing now, and what more they can do, to mitigate the health effects of social isolation and improve other social determinants of health arising from the pandemic.
Here's what they talked about:
- The impact of social isolation on older adults
- How providers are increasing outreach to older patients
- How payers are connecting members with support services
- The rapidly expanding role of telemedicine
- A direct approach to addressing social determinants
- Mental health disorders post-pandemic: a forecast
Episode Resources
- Jeff Barkin's bio
- Victoria Pham's bio
- Monique Yohanan's bio
- Kelly Cavin's bio
- Address Social Determinants of Health with Community Advocacy
- Eligibility & Enrollment with Member Engagement Support
- My Advocate Eligibility and Enrollment Solutions
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
Healthcare IT teams had to move quickly when social distancing requirements shuttered offices, and large numbers of employees started working from home. Suddenly the question was: How does an organization safely continue operations during a pandemic? What are the new business continuity, cybersecurity, and privacy considerations? What immediate actions should be taken?
On today's show, John Zuziak, Change Healthcare's Security and IT Risk Management Practice Director, talks "cybersecurity in our new world" with Eric Decker, CIO; Peter Jabrucki, CISO; and LeMar Ward, Business Continuity and Disaster Recovery manager, all with Independent Health, a not-for-profit health plan headquartered in Buffalo, New York.
These IT leaders discuss how and why they've been preparing for a crisis such as this one, and what actions they've taken to manage the new requirements and new risks posed by having a substantial workforce rapidly "lift and shift" from on-site to remote teams.
Here's what they covered in their panel discussion:
- Planning ahead to get a jump on a crisis
- How a snowbelt HQ helped the company prepare for the pandemic
- The importance of a WFH (work-from-home) trial run
- Identifying and preventing staffing gaps in key IT areas, including third-party vendors
- Handling the uptick in cybersecurity risks from targeted phishing, teleconferencing technology, and data breaches due to WFH support
- The need to educate, but not overwhelm, IT and remote staff about cybersecurity risks
- Monitoring off-site sign-ons and potential breaches
- Managing a higher volume of incident reports
- Looking ahead: Predictions of how healthcare IT will change as a result of the pandemic
Episode Resources
- John Zuziak's bio
- Eric Decker's bio
- Peter Jabrucki's bio
- LeMar Ward's bio
- Independent Health's website
- Change Healthcare Consulting Services resource hub
- Change Healthcare Consulting Services
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Suggest or become a guest
- Contact Change Healthcare
The COVID-19 pandemic is putting unprecedented strain on the healthcare system. And while the challenges facing the front-line healthcare providers are most obvious and concerning, payers are not immune. They're facing hurdles driven by new codes, regulatory changes, and a surge in telehealth that challenges the ability to accurately process timely payments–a critical issue for providers.
On today’s episode, Dr. Frank Dubeck, chief medical officer for Payment Accuracy at Change Healthcare, joins Mike Boykin, value consultant; Tracy Mullen, manager of Clinical Development; and Kathleen Reid, product management leader for Clinical Claims Management to discuss claims code editing considerations during the global health emergency.
Here are the high points of their conversation:
- New codes developed to deal with COVID-19
- Editing to address the influx of telemedicine claims
- Demystifying CMS and CPC telemedicine coding conflicts
- COVID-19 diagnostic coding
- Reviewing rules configuration in ClaimsXten to reduce denials
- Frequency rules editing
- How bundling rules are impacted
Episode Resources
- Amy Larsson's bio
- Dr. Frank Dubeck's bio
- Mike Boykin's bio
- Tracy Mullen's bio
- Kathleen Reid's bio
- Webinar: Claims Management and Payment Accuracy in a Pandemic
- ClaimsXten
- Coding Advisor Pre-Submission Claims Adjustment
- COVID-19 Updates & Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Welcome to the Capitol Connection, a quarterly update on what's happening on Capitol Hill and various state legislature sessions around healthcare policy. Your hosts are Deanne Kasim, Executive Director of Health Policy at Change Healthcare, and Angela Evatt, Senior Manager of State Policy Strategy at Change Healthcare.
Here's what's covered in this edition:
- CMS guidance regarding telemedicine waivers during the COVID-19 pandemic
- Suspended legislative sessions in 26 states (and counting)
- State-regulated insurance companies waive cost-sharing for COVID-19 testing
- State-directed Medicaid programs to cover COVID-19 testing/treatment
- Reopening of state-run insurance exchanges, demands for federal enrollment period
- Driving capacity with state-mandated suspensions of licensure requirements and elective procedures
- Health plan deadlines for CMS interoperability final rule and information blocking final rule
- ONC fact sheets, education regarding rule components
- Contention over private right of action
- Disagreement on Washington State Privacy Act amendments derails progress
- Second update released to California's Consumer Privacy Act
- States introducing data privacy legislation
- Medicaid work requirements and Medicaid expansion reform
- Oklahoma push to convert a portion of Medicaid into a block grant
- Details of Colorado’s public health option bill and hospital/insurer opposition
- California's new Healthcare Affordability Office charged with lowering costs
- The COVID-19 pandemic’s potential impact on our healthcare system and policy development
Episode Resources
- Deanne Kasim's bio
- Angela Evatt's bio
- Everything You Dare to Ask About Healthcare Interoperability
- Price Transparency is Coming for Payers, Providers, and Pharma. Are You Ready?
- The New PAMA Math
- Interoperability Solutions for Healthcare
- Advancing the Use of APIs in Healthcare
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Start-ups and mid-sized companies are innovating new IT solutions to solve challenges in the healthcare industry. One of the issues these development teams face is deciding whether to build all functionality in house, or focus on their strengths and integrate best-of-breed functionality where possible–speeding time to market in the process.
In this podcast, Aakarsh Sethi, product manager at INFINX Healthcare, walks us through his company’s thought process as they brought an innovative patient-access solution to fruition, solving their build vs. buy conundrum in the process.
Here’s what Aakarsh discusses with Gautam “G” Shah, vice president of Platform and Marketplace at Change Healthcare, on today's show.
- Questions to ask when developing out a new HIT solution
- Balancing product purpose with end-user needs
- The “build vs. buy” decision
- APIs as building blocks for innovation
- The difference between APIs and APIs with broad connectivity
- Understanding the value of API integrations
- How FIHR could change data exchange within the next five years
Episode Resources
- Aakarsh Sethi's bio
- Gautam "G" Shah's bio
- HFMA: Accelerating Healthcare Innovation by Productizing APIs
- Google Cloud: Building an API Marketplace for the Healthcare Industry
- Change Healthcare Unveils API & Services Connection, a Marketplace to Accelerate Innovation in Healthcare
- API & Services Connection™ for Healthcare
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
For the past 10 years, Change Healthcare and the HealthCare Executive Group (HCEG) have commissioned the Industry Pulse Research Report, an annual effort to "take the pulse" of the healthcare industry. The insights gleaned from this year's research reflect responses from 445 payer and provider leaders, 80% of which are director level or above.
To dig into the results, show hosts Rich Levin and Grant Evans met with Ferris Taylor, executive director of the HCEG; market researcher Michael Brousseau, of Insight Dynamo; and David Gallegos, senior vice president of Consulting Services at Change Healthcare. Here's what the panel discussed:
- The history and purpose of the Industry Pulse
- Research methodology and respondent breakdown
- Industry maturity of consumer-centric strategies
- How provider fragmentation and a focus on acute patients limits insight into the full consumer population
- Payers or providers: Who should provide cost/quality data to consumers?
- Building the research's value-based care maturity model
- Understanding the value-based care gap between payers and providers
- The interoperability gap
- Overcoming mistrust between payers and providers
- Key factors for achieving healthcare interoperability
- Consumerism, aligned incentives, and the success or failure of supply chain interoperability
- Payers and providers on the impact of AI
- Reaping the rewards of AI-driven innovation
- The leadership gap on cybersecurity defenses
Episode Resources
- David Gallegos's bio
- Ferris Taylor's bio
- Michael Brousseau's bio
- Change Healthcare Releases the 2020 Industry Pulse Report
- The 2020 Industry Pulse Report ebook
- The HealthCare Executive Group
- Change Healthcare Consulting Services
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Healthcare consumers are frustrated by the mix of medical bills they receive from multiple providers. Rachel Mertensmeyer started RexPay® to help consumers understand, manage, and pay all those medical bills in one place, through a simple smartphone app. But what consumers don't see when they use the app is something working behind the scenes: the Change Healthcare API & Services Connection, which helps power the solution.
On today's show, Serrah Linares, vice president of Partnerships at Change Healthcare, chats with Rachel about why she created the RexPay app, and how it’s helping consumers and providers make short work of managing their medical bills.
Here's what they talked about:
- The 36 medical bills that led to RexPay app
- Why the app is named after Rex the rescue dog
- How providers and consumers use RexPay
- The pressing need for a solution like RexPay
- Awards, accolades, and grants earned by RexPay to date
- How APIs bring RexPay and Change Healthcare technologies together
- Why consumers are becoming more engaged in their healthcare finances
- Consumer data: How to deliver it safely and effectively
- How providers and consumers can connect with RexPay
Episode Resources
- Serrah Linares's bio
- Rachel Mertensmeyer's bio
- RexPay website
- RexPay for iPhone
- RexPay for Android
- RexPay demo for providers
- RexPay webinar for providers
- RexPay Selected as Awardee in Arizona Innovation Challenge
- Medical Bill Tracker, Payment App Launches, Gets Innovation Award
- Change Healthcare Unveils API & Services Connection, a Marketplace to Accelerate Innovation in Healthcare
- Advancing the Use of APIs in Healthcare
- API & Services Connection™ for Healthcare
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
The Protecting Access to Medicare Act (PAMA) becomes mandatory in 2020. It promotes evidence-based medicine by requiring consultation of appropriate use criteria (AUC) when ordering Medicare part B advanced imaging, and evidence of such consultations in order for claims to be paid by the CMS.
On today's podcast, Change Healthcare's Bob Cooke discusses PAMA with Sean McCormick, MD, and Natasha Stjepanovic, Care Select Imaging team product manager. Here's what ground they covered.
- PAMA requirements
- Why PAMA legislation was needed
- Integrating decision support into the EHR workflow
- How to meet PAMA's AUC requirements
- Inside PAMA consultation requirements
Episode Resources
- Bob Cooke's bio
- Dr. Sean McCormick's bio
- Natasha Stjepanovic's bio
- PAMA regulations
- PAMA portal
- CareSelect Lab
- Change Healthcare announces CareSelect Imaging Open Access
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Organizations around the world are hungry to capitalize on the immense potential of AI, machine learning, and deep learning. But sometimes in their haste to apply AI to solve problems, these well-meaning organizations overlook their end users.
What are the users' needs? After all, they're the people who need to interact with the AI model's output, and based on that output, might need to change behaviors, habits, workflows, or more as a result. Such "cognitive collaboration" is a new concept for most organizations to understand and apply so they can make the most of AI.
On today's show, Change Healthcare's Adam Sullivan, senior director of Artificial Intelligence, and Keith Roberts, vice president of Engagement, have a lively discussion about how AI works with humans in healthcare, and what organizations need to know to ensure cognitive collaboration works.
Here's what they hit on:
- How the precision of AI is helping reinvent engagement
- Thinking about the user and the idea of augmented decision-making
- Why gaining an empathy-based understanding of users is critical to the success of AI
- What mindset an organization needs to embrace AI
- The role of behavioral scientists
- The 400-page medical record: human vs. machine or human plus machine?
- The human implications of problem solving with AI
- Factors that affect AI program success
Episode Resources
- Adam Sullivan's bio
- Keith Roberts' bio
- Artificial Intelligence and Healthcare
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Artificial intelligence (AI) is transforming the business of risk adjustment—the science of predicting the level of disease burden of an individual. On today’s show, Adam Sullivan, Ph.D., senior director of AI at Change Healthcare, interviews Curt Vinyard, vice president of Product and Strategy at Change Healthcare, to dig into the impact AI is having in risk adjustment analytics, and what payers and providers need to know about this disruptive innovation.
Here's what Adam and Curt covered:
- Risk adjustment yesterday, today, and tomorrow
- The ah-ha moment that will change your thinking about AI and risk adjustment
- How AIs can reduce administrative overhead in risk adjustment
- Delivering risk adjustment information to physicians to help them improve compliance
- Helping physicians use AI analytics to make the right care decisions
Episode Resources
- Adam Sullivan's bio
- Curt Vinyard's bio
- Artificial Intelligence and Healthcare
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
"Data-driven insight" is becoming a driver of operational efficiency for payers, providers, and other healthcare stakeholders. But in most cases, the available data is limited to an individual organization or a region. What happens if we scale up the amount of data available for analysis by sourcing from across the country and from all major types of care and delivery models?
On today’s show, Tim Suther, Senior Vice President of Data Solutions at Change Healthcare, discusses how this economic healthcare data can be used to help improve the efficiency of the entire healthcare system, as well as the performance of individual organizations. As Tim says, “If you don’t have real-world healthcare data, then you just have an opinion.”
Here's what we talked about on today's show:
- Importance of unbiased, independent data collection and analysis
- Improving the cost-effectiveness of healthcare with data analytics
- Shifting the national focus from care coordination to the healthcare system
- Improving outcomes, optimizing performance, and accelerating innovation
- Impact of data analytics on payers, providers, policy makers, and consumers
- Taking healthcare’s daily economic pulse via a substantial volume of claims data
- Aggregating simplified claims data across the healthcare industry
- What is the process of deidentifying healthcare data, and how is it regulated?
- Controlling/permissioning the uses of healthcare data
- Data delivery models: structured reports, custom reports, and hosted services
- Measuring utilization and population health across local, regional, and national markets
- Moving beyond performance improvement to true benchmarking
- Price transparency and shopping for care by cost, experience, and quality
- Achieving the triple aim through healthcare consumption data
- Policy uses of comparing a community’s healthcare profile with national trends
- Using data for real-world evidence and health economic outcomes research
- Giving payers visibility into all dimensions, geographies, and specialties
- Deidentified data and the push to curb wasteful spending
- Principles for the ethical application of real-world data
- Advice for beginners: goals to consider
Episode Resources
- Tim Suther's bio
- Why the Healthcare Crisis is Really an Information Problem
- Data Solution website
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Hospital Laboratories Must Think Critically and Evaluate Carefully Before Launching Decision Support Projects
Practicing medicine today is more complex than ever. The menu of diagnostics, medications and treatments available to providers is continually expanding. Standards of care are shifting as guidelines grow and multiply. There are more options and more decisions for everyone–from practitioners to laboratory technicians to IT staff.
Second in a three-part series developed in collaboration with Mayo Clinic.
By Ben Gold and James Colbenson
Ben Gold is CareSelect™ Lab Product Manager at Change Healthcare. James Colbenson, MBA/MHA, is Director of Commercialization, Value-Based Medicine for Mayo Clinic Laboratories.
Episode Resources
- Ben Gold's bio
- James Colbenson's bio
- Mayo Clinic
- CareSelect Lab
- Align Lab and the Hospital’s Strategic Priorities
- Reality Check: Buy Versus Build for Laboratory Decision Support
- Clinical Laboratories at a Crossroads
- Change Healthcare announces CareSelect Imaging Open Access
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Payment integrity audits--the process of ensuring that payments to providers are accurate--can be a costly and time-consuming proposition for providers. Payers or their third-party vendors routinely audit claims to ensure providers applied appropriate care, utilization, and billing codes.
But how abrasive is the process? And are there any ways to minimize the impact on payer-provider relationships? Change Healthcare commissioned Frost & Sullivan to look into this issue. The results are eye opening and informative for both payers and providers.
On this episode of the Change Healthcare podcast, Dave Cardelle, vice president of Payment Integrity and Coding Advisor Solutions at Change Healthcare, shares what was learned from the research. Here's what was covered:
- What drove the research into DRG audits, and what was involved
- Top-line research takeaways
- How the payment audit process works
- Is potential damage from audits to provider relationships rooted in cost, administrative burden, or time requirements?
- How providers can tackle the volume of payers' medical record requests
- How to improve the audit process
- Provider sentiment on pre-submission notification
- How payers can evolve their payment integrity programs to improve provider relationships
- The medical record request process
- Many providers have no idea what payment audits cost their organization
- Who’s outsourcing, and why
- Payers’ use of “stacked vendor” auditing processes and the risks
- What payment audits costing payers and providers
Episode Resources
- Dave Cardelle's bio
- Research: The Impact of DRG Audits on Provider Sentiment and Abrasion
- Change Healthcare Study Reveals Impact of Payment Audits on Payer-Provider Relationships
- Change Healthcare Coding Advisor
- Frost & Sullivan
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Welcome to the Capitol Connection, a quarterly update on what's happening on Capitol Hill and various state legislature sessions around healthcare policy. Your hosts are Deanne Kasim, Executive Director of Health Policy at Change Healthcare; and Angela Evatt, Senior Manager, State Policy Strategy at Change Healthcare.
Here's what's covered in this quarter's report:
- The trend of state-based broad data privacy bills
- State vs. federal privacy provisions & the California Consumer Privacy Act
- Compliance challenges of juggling multiple state laws instead of one federal law
- How should health app data & other non-HIPAA regulated data be governed?
- Bringing transparency to how data is used without stifling innovation
- States testing public insurance options and addressing challenges to the ACA
- State approaches to Medicaid expansion, including the block grant system
- Petitions to CMS to add work requirements to state Medicaid programs
- CMS price cost transparency rules and related litigation
Episode Resources
- Deanne Kasim's bio
- Angela Evatt's bio
- Everything You Dare to Ask About Healthcare Interoperability
- Getting A Second Opinion on Healthcare with Senator William Frist
- Price Transparency is Coming for Payers, Providers, and Pharma. Are You Ready?
- The New PAMA Math
- Interoperability Solutions for Healthcare
- Advancing the Use of APIs in Healthcare
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
What was once the realm of science fiction has become science fact. It's no exaggeration to say that artificial intelligence is now woven into the fabric of daily life. Voice assistants, image recognition, autonomous vehicles, customer support bots, robotics, e-commerce—the value of AI keeps growing across industries, including healthcare.
And the value for healthcare isn't limited to clinical pursuits. AI is now serious business in the clinical, financial, and engagement arenas. On today's show, Change Healthcare executives Nick Giannasi, Ph.D., EVP and Chief AI Officer, and Frederick Eliasson, EVP and CFO, provide a backgrounder on AI in healthcare, discuss AI's impact on healthcare's cost/quality curve, and explain how and why Change Healthcare embedding AI into our financial, clinical, and engagement solutions.
- How to explain artificial intelligence and machine learning to anyone (1:48)
- Why we need AI in healthcare (7:15)
- The “four enablers” that make AI relevant for healthcare (11:58)
- Why Change Healthcare’s platform is fertile ground for AI-infused solutions (14:57)
- Examples of how AI is helping providers and payers today (21:00)
- The risks and challenges of applying AI in healthcare (28:25)
Episode Resources
- Nick Giannasi's bio
- Fredrik Eliasson's bio
- Artificial Intelligence and Healthcare
- How to Improve Claims Lifecycle Management with AI
- How to Prevent Denials with AI
- How to Identify Missing Charges with AI
- How to Modernize Dual Enrollment with AI
- Change Healthcare Brings AI to CareSelect™ Imaging
- Change Healthcare Artificial Intelligence Rewrites the Rules of Charge Capture
- New AI from Change Healthcare Can Help Providers Prevent Denials
- Change Healthcare Unveils Claims Lifecycle Artificial Intelligence
- Change Healthcare and Health Fidelity Partner to Increase Quality and Accuracy of Risk Adjustment Coding
- Change Healthcare Fuses Artificial and Human Intelligence for Medicare Advantage Dual Eligibility and Enrollment
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Electronic claims submission is now the norm in healthcare. Yet claims attachments––the clinical and other supporting documentation submitted to payers––remain mired in fragmented manual workflows that still rely on phone calls, paper pushing, and fax machines.
But that's changing. On today's show, we discuss the rapid evolution of payer-provider data exchange that's happening right before our eyes. Our expert panel shares compelling insights on new HIT capabilities that can help providers pull the plug on the fax machine and go "all electronic" with virtually all clinical documentation they need to share with payers to support claims payment. The result can be a great increase in efficiency, error reduction, manageability, cost savings, and revcycle velocity.
Our Change Healthcare panelists: Mike Peresie, senior vice president and general manager of Medical Network; Sajid Khan, senior vice president and general manager of Dental Network; and Adam Sullivan, senior director of Artificial Intelligence.
Here's what the panel covered:
- Growing momentum towards full-scale interoperability
- The network is the advantage
- How data analytics and arbitrage in boosting collections
- Lessons learned in the dental market
- Artificial intelligence and natural language processing step up
- Creating a "claims superhighway" for clinical documentation
- Getting payers and providers to move on from legacy methods
- How payers and providers can partner to go all-electronic
Episode Resources
- Mike Peresie's bio
- Sajid Khan's bio
- Adam Sullivan's bio
- Change Healthcare Medical Claim Attachments
- Change Healthcare Dental Claim Attachments
- How to Reduce the Cost of Claim Attachments
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Hospitals must choose best path forward amid major industry changes
Powerful forces are reshaping the clinical laboratory industry. Deep reimbursement cuts threaten to upend traditional business models. Ongoing commoditization continues to exert margin pressure. Capital requirements are rising as budgets erode. And uncertainty is widespread about how best to manage costly esoteric testing in a value-based world.
by Ben Gold and Don Flott
Ben Gold is CareSelect™ Lab Product Manager at Change Healthcare. Don Flott is Senior Director of Value-Based Medicine at Mayo Clinic Laboratories.
Episode Resources
- Ben Gold's bio
- Don Flott's bio
- Mayo Clinic
- CareSelect Lab
- Align Lab and the Hospital’s Strategic Priorities
- Reality Check: Buy Versus Build for Laboratory Decision Support
- Clinical Laboratories at a Crossroads
- Change Healthcare announces CareSelect Imaging Open Access
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Collaboration, Coordination, Improved Workflows, and Reduced Patient Wait Times Can Result from Transformation
The effective collection, use and sharing of information to help streamline processes and deliver quality patient care is a persistent and overriding challenge for hospitals, radiology clinics, and physicians alike. Ultimately, the beneficiary is the patient as reduced wait times, report turnaround times and higher levels of service delivery become attainable goals for organizations. Key to achieving these goals is the consolidation of health information, better resource allocation and utilization, the harmonization of clinical and business processes, and a data-driven continuity program–a true service transformation.
Episode Resources
- Four Leading Providers Join Change Healthcare and Google Cloud in Next-Generation Enterprise Imaging Initiative
- Enterprise Medical Imaging Solutions
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Laboratory Data Key to Overcoming Medicare Cuts
Harnessing data can reduce waste, increase margins, and improve clinical outcomes
Based on a presentation from the 2019 Dark Report Executive War College benefactor session, featuring Don Flott, Senior Director of Value-Based Medicine at Mayo Clinic Laboratories; David Figueredo, National Vice President of Sales for Technology Enabled Services at Change Healthcare; Sarah Boyd Simonson, Director of Lab Client Management at Change Healthcare; and Ben Gold, Product Manager for CareSelect Lab at Change Healthcare
Episode Resources
- Mayo Clinic
- CareSelect Lab
- Change Healthcare announces CareSelect Imaging Open Access
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Unchecked out-of-network (OON) charges can result in high surprise bills for patients and high costs for payers. One reason: The cost for out-of-network care is often well above national averages and norms. It's crucial for payers to protect their members from larger deductibles and out-of-pocket limits by minimizing the risk associated with OON care. And in doing so, payers can also improve employer savings, administrative and medical cost savings, and appeals processes.
On today’s show, Mary Canobbio interviews Anna Bash, claims manager at third-party administrator Employee Plans, and discusses how a claims repricing network can help reduce excessive expenses and protect members by discounting OON claims in collaboration with providers.
Here's what they dug into:
- The impact of political instability on the healthcare market
- How a small percentage of OON claims can lead to increased premiums
- Generating savings through OON risk mitigation
- The impact of OON claims on members and their employers
- How direct negotiation with non-contracted providers offers payers a safety net
- Removing the threat of balance billing for members
- Why member savings are greater than the distributed cost of repricing
- How contractual compliance with coding standards can drive payer savings
- Exploring fair market pricing as a network alternative
Episode Resources
- Anna Bash's bio
- Nanci Ziegler's bio
- Change Healthcare Integrated Repricing Network
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
A recent JAMA article identified six domains of healthcare that are responsible for $935 billion in wasted healthcare spend annually:
- Failure of Care Delivery
- Failure of Care Coordination
- Overtreatment/Low-Value Care
- Pricing Failure
- Fraud and Abuse
- Administrative Complexity
That accounts for a staggering 25% of all healthcare dollars. On today's show, Change Healthcare's Chrissy Finn, Laura Coughlin, and Dr. Sean McCormick evaluate how the industry can address JAMA's Six Domains of Healthcare Waste. These include:
- Evidence-based medicine, team-based care, and alternative payment models (02:40)
- The role and responsibilities of stakeholders in reducing waste (09:17)
- Effective care coordination and management, and better engaging patients in their care (12:33)
- The highest priorities in reducing administrative complexity (16:40)
- Personalizing medicine via pharmacogenetics, predictive modeling, and AI (21:50)
Episode Resources
- Chrissy Finn's bio
- Laura Coughlin's bio
- Dr. Sean McCormick's bio
- JAMA announcement
- Healthcare Finance News article
- Change Healthcare InterQual
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Managing the highly regulated areas of Medicare Parts C and D can be a daunting challenge for health plans. Factor in a CMS audit, and the complexity and associated administrative burden can skyrocket.
On today's program, Change Healthcare Consulting's Phillip Cardona, Melissa Bailey, and Tim Gundlach explain CMS audit universes; managing the considerable amount of data they can require; and best practices for preparing for and facilitating the audit process.
Here's what they reviewed:
- CMS and the role of “audit universes” (00:34)
- What audit universes mean to health plans (01:55)
- Audit universes defined and how they're changing next year (04:18)
- Recommendations for providing “clean” universes to facilitate the audit process (09:39)
- Best practices for ensuring accurate data sources (11:43)
- Preparing for the data validation webinars with auditors (13:13)
- The need for periodic monitoring (14:32)
- How a Medicare audit tool can help reduce the administrative burden (16:25)
Episode Resources
- Phillip Cardona's bio
- Melissa Bailey's bio
- Tim Gundlach's bio
- Consulting Resource Center
- Change Healthcare Consulting Services
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
While many out-of-network (OON) providers charge reasonable prices for their services, insurers must also cope with excessive OON charges, which undermine members’ financial security and fuel rising healthcare costs. What percentage of these claims should be paid, and how can insurers better protect their members from debilitating balances?
On today's show, Marcus James, Senior Vice President of Claims and Membership for Arkansas BlueCross BlueShield, joins Nanci Ziegler, Vice President of Strategic Clients at Change Healthcare, to discuss what goes into developing a successful OON strategy, how a comprehensive approach can benefit members and providers, and why payers should take a hard look at their current OON approach.
Here's what they covered:
- Non-par providers and what defines an out-of-network claim (01:18)
- Two growing problems: surprise balance billing and ER pricing at walk-in clinics (02:23)
- Why balance billing vs. paid-in-full OON claims is a lose/lose proposition (03:53)
- The impact of an OON strategy on combating excessive OON claims billings (05:26)
- Arizona BlueCross BlueShield conditions for out-of-area OON rate negotiations (06:49)
- What's an Integrated Repricing Network, and how much of the country can it cover? (09:00)
- Protecting members by preventing balance billing on 20-25% of OON claims (10:23)
- How to give faster reimbursement and other benefits to OON providers (11:55)
- Where an OON strategy becomes a value-added service for employer groups (13:07)
- Payment integrity innovations to reduce provider abrasion (14:10)
Episode Resources
- Marcus James' bio
- Nanci Ziegler's bio
- Unraveling Out-of-Network Surprise Medical Bill Legislation
- Integrated Repricing Network
- Payment Accuracy Solutions
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Healthcare interoperability: Where is the industry at today, where is it going, what's new, what's coming, and most important–what do payers, providers, and vendors need to do in order to participate in healthcare's interoperational future?
These questions and more are fielded on today's show by Jitin Asnaani, former Executive Director of CommonWell Health Alliance; Kashif Rathore, VP of Interoperability at Cerner; and Nicole Antonson, VP of Identity and CommonWell Services at Change Healthcare.
Covered on today's broadcast:
- Why we're all students of interoperability (03:58)
- Meaningful Use Stage Two, the need for an interoperability alliance, and the birth of CommonWell (09:08)
- Promoting the free exchange of information: Why Cerner became a founding member of CommonWell (16:04)
- Interoperability: What's in it for providers? (21:40)
- The greatest barriers to interoperability for providers (26:54)
- How clinical interoperability exchange can help drive better outcomes (37:12)
- Where healthcare interoperability sits on the maturity curve (45:07)
- Coming federal interoperability rules (54:44)
- What providers can expect from CommonWell in the future (1:05:17)
- What's next for interoperability in healthcare IT (1:13:37)
- Next steps for providers: Preparing for an interoperable industry (1:18:17)
Episode Resources
- Jitin Asnaani's bio
- Kashif Rathore's bio
- Nicole Antonson's bio
- CommonWell Health Alliance
- Cerner
- CommonWell Health Alliance Awards Change Healthcare Six-Year Contract to be the Provider of Clinical Interoperability Services
- Interoperability Solutions for Healthcare
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Using digital technology to attract, engage, and serve consumers; deliver exceptional experiences; and earn loyalty is old hat for many U.S. industries. Healthcare, however, remains woefully behind the times when it comes to delivering contemporary digital experiences to consumers.
But that’s changing, and fast. On today's show, experts from Adobe, Microsoft, MDSave, and Change Healthcare have a robust discussion about why healthcare lags behind, the impetus to move quickly, the risks of not doing so, what the personalized patient experience looks like, and much more. It's a must-hear for any payer or provider.
Here’s what the panel debated:
- The digital healthcare experience imperative (04:52)
- A new notion: the “Orchestrated Digital Journey” (21:27)
- Price transparency and its connection to patient satisfaction and collections (25:29)
- What a personalized patient experience looks like (31:44)
- How we can help patients improve their experience while lowering healthcare costs (42:50)
- Connecting access points to provide a seamless healthcare experience (53:57)
- Digital transformation from the platform point of view (59:30)
- How the orchestrated digital journey can impact care quality and patient health (1:12)
Episode Resources
- Bill Krause's bio
- Kathleen McGrow's bio
- Paul Ketchel's bio
- Tom Swanson's bio
- Digital Patient Experience Manager
- Price Transparency in Healthcare
- Practical Innovation
- Change Healthcare 2019 Consumer Insights Report
- Change Healthcare True View
- Change Healthcare Patient Access Suite
- Change Healthcare Clearance Estimator
- Change Healthcare Clearance Authorization
- Change Healthcare makes strategic investment in MDsave
- Change Healthcare partners with Adobe and Microsoft
- Adobe's website
- Change Healthcare's website
- MDsave's website
- Microsoft's website
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Not long ago healthcare IT systems were information silos, safely isolated inside a payer’s or provider’s data center. The greatest threat to IT security was the unlikely inside job. Fast forward to 2019, and HIT systems are increasingly enmeshed across corporate, government, vendor, and even consumer boundaries. Information is flowing between multiple on-premise and cloud data centers; among vendors, software services, and APIs; and often across the public Internet.
The threat landscape healthcare organizations must mitigate today is greater, more complex, and evolving faster than ever. But while the IT world we work in gets more challenging by the day, the disciplines and how to manage the environment have also improved dramatically. Practices such as HITRUST certification and SOC audits are helping IT teams evaluate their organizations and ensure adherence with the highest security protocols and standards.
On today’s show, Bob Hoover, Vice President of Change Healthcare Consulting, discusses the state of IT security and where HITRUST, SOC 2, and enterprise risk management fit in with Haddon Bennett, Chief Information Security Officer at Change Healthcare; and Rusty Fancher and Susan Richards, Program Directors of Enterprise Information Security at Change Healthcare. Here's what they hit on.
- HIPAA compliance, HITRUST’s controlled framework, and SOC 2: What’s the difference? (03:05)
- A top-down approach to establishing enterprise information security governance, policy implementation, and performance measurement (08:48)
- Resources and skill sets required to build, troubleshoot, and manage enterprise information security programs (13:22)
- Establishing an information security mindset (18:46)
- Which way to go: Comparative benefits and a rationale for choosing either SOC 2 audits and reports or HITRUST certification (23:32)
- Instituting sound security policies and procedures, risk assessments, and data protection regulations (30:33)
- SOC report types and HITRUST scoring models (36:32)
- How to assess HITRUST certification value for an organization (38:15)
Episode Resources
- Bob Hoover’s bio
- Haddon Bennet’s bio
- Rusty Fancher's bio
- Susan Richards’ bio
- Consulting Resource Center
- Change Healthcare Consulting Services
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Advances in technology boost providers’ ability to screen the self-pay patient.
by Brian Andrews
Brian Andrews is Senior Vice President & General Manager of Revenue Optimization Solutions at Change Healthcare.
Episode Resources
- Brian Andrews' bio
- Coverage Insight
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Payers can reap profound cost savings by moving their provider networks from paper to electronic payment (e-payment). But after 20 years of encouraging various forms of e-payment, only 60% of medical providers are accepting them.¹
Imagine if only 60% of other forms of commerce accepted electronic payments. Why the snail’s pace in healthcare?
Listen in as Bill Barbato and Jason Koch share their answers to this question, and review how e-payment continues to challenge payers, and ways payers can break the logjam to boost e-payment adoption.
Here are the topics they touched on:
- The lingering impact of early industry missteps when introducing e-payment (02:40)
- New e-payment options that help overcome providers' reluctance (06:17)
- The e-payment approach smaller-volume providers often embrace first (08:39)
- Why offering multiple e-payment options is essential (10:57)
- Obstacles: Enrollment and the lack of EDI delivery (15:02)
- Electronic payment impact on the reconciliation process (18:07)
- How to send high-quality electronic remittance advice (20:48)
- Achieving win-win relationships with providers (26:43)
Episode Resources
- Bill Barbato's bio
- Jason Koch's bio
- Virtual Provider Payments: The Good, The Bad, The Opportunity
- The Importance of High-Quality Electronic Remittance Advice (ERA)
- Make It Easy for Providers to Choose Electronic Payments
- Covenant Administrators Shares Results
- Change Healthcare Payment Management Solutions
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
1 Source
It's no secret that artificial intelligence (AI) is changing healthcare's approach to imaging. As AI algorithms are added to new and existing solutions, AI is helping clinicians make appropriate clinical decisions faster.
We interviewed Ran Rumianek, Executive Director of Artificial Intelligence and Growth at Change Healthcare, to dig into the rise of AI in imaging, its promise and apparent benefits, and advice for how providers can harness the potential of AI today and in the future.
Here's what was covered in the interview:
- How AI can help automate repetitive tasks for administrators and clinicians (01:30)
- Narrow vs. general AI, and the impact on productivity and patient care (04:34)
- Interpretation and the radiologist’s evolving role in an AI world (07:21)
- The psychological impact of AI on clinician job satisfaction (08:59)
- Obstacles to AI adoption and how to address them (10:41)
- AI's benefits: hype or reality? (13:00)
- The nexus of cloud-based services, AI, and accessibility for imaging (14:20)
- Guidance for IT leaders preparing for AI (16:51)
Episode Resources
- Ran Rumianek's bio
- Schedule a demo
- Enterprise Imaging Solutions
- Enterprise Imaging resource center
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Vendor-neutral archives (VNAs) have provided secure, consolidated data storage to providers for years. But the definition and capabilities of the VNA are changing. The VNA is moving to the cloud, and that's raising new questions for providers, because not all cloud VNAs are created equal. Some are rehosted legacy solutions, others are hybrids, and still others are built from the ground up for cloud computing—and those distinctions have implications for VNA implementations.
On today’s show, Todd Doherty, Director of Product Management and Data Services at Change Healthcare, reviews the evolution of VNAs, updates us on where the industry is at today and where it's heading, and what we can expect to see in the future.
Here's what we talked about.
- A brief history of VNAs (01:55)
- The difference between cloud-based, cloud-native, and on-premise (06:05)
- How SaaS (software as a service) impacts financial forecasting and budgeting (07:52)
- Supporting emerging use cases through data accessibility and open systems (10:30)
- The VNA of tomorrow (13:23)
- Jump-starting your organization’s VNA vision (16:14)
Episode Resources
- Todd Doherty's bio
- Schedule a demo
- Enterprise Imaging Solutions
- Enterprise Imaging resource center
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Healthcare organizations increasingly see enterprise imaging as crucial to the development of a more comprehensive electronic health record. And as more providers consolidate their medical imaging infrastructure, they’re learning how integrating with the EHR can help increase the value of their existing HIT investments.
On today’s show, Steve Harrold, Senior Manager of Enterprise Imaging at Change Healthcare, talks about the potential advantages of multitenancy, the need for a cybersecurity infrastructure, and how telling the story of the patient’s condition through imaging can lead to better outcomes.
Here's what we discussed:
- How enterprise imaging can help reduce clinical variance and combat physician burnout (01:19)
- The C-suite’s focus on EHRs and enterprise imaging (02:43)
- How concentrated integration can improve information flow (03:37)
- Why role-based views of images and reports matter for results interpretation and patient consults (04:37)
- The trend toward EHR and cloud-native imaging convergence (07:06)
- What "cloud-native" architecture means (09:26)
- How display protocols can increase diagnostic confidence (13:38)
Episode Resources
- Steve Harrold's bio
- Schedule a demo
- Enterprise Imaging Solutions
- Enterprise Imaging resource center
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
As more organizations adopt enterprise imaging solutions that cross service lines, improvements in care team coordination are having a positive impact on throughput, clinical collaboration, and patient outcomes.
On today’s show, Steve Harrold, Senior Manager of Enterprise Imaging at Change Healthcare, talks about these improvements, including the importance of workflow engines, advancements in AI algorithms, and how to keep diagnosticians on the front lines of healthcare.
Here's what we covered:
- Improving patient throughput and intra-department communications (01:55)
- Incorporation of AI algorithms into workflow engines and the impact on clinicians (03:48)
- How intelligent views can reveal disease progression (06:03)
- Adjusting turnaround times around specific conditions to support better outcomes (07:57)
- How a mobile experience can make or break encounter-based capture (09:18)
Episode Resources
- Steve Harrold's bio
- Schedule a demo
- Enterprise Imaging Solutions
- Enterprise Imaging resource center
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Revenue cycle management (RCM) is more than simple claims management and bill processing. Today, RCM is a rapidly changing, multi-billion dollar market with a complex set of challenges and a growing roster of healthcare IT (HIT) vendors promising to solve them.
On today's show, Thomas Laur, executive vice president at Change Healthcare and president of the company’s Technology Enabled Services business, brings us inside this rapidly evolving space and talks about what’s driving change, the role of new technologies such as advanced analytics and artificial intelligence, and how forward-thinking providers can mix HIT and services to optimize RCM and engage patients more effectively.
Here's what's covered in today's show:
- How revenue cycle management is evolving
- Data analytics, arbitrage, and their role in increasing collections
- Key areas for RCM disruption in the next five years
- How providers can drive new payment paradigms and adoption of intelligent technologies
- Do intelligent RCM technologies require providers to add new skill sets?
- Balancing technology, professional services, and consulting to maximize ROI from intelligent RCM technologies
- Revenue cycle is becoming more patient-centric
Episode Resources
- Thomas Laur’s bio
- Artificial Intelligence Equals Real Transformation for Revenue Cycle Management
- Revenue Optimization Resource Library
- Revenue Cycle Optimization Webinar Series for Hospitals and Health Systems
- COVID-19 Updates and Resources
- COVID-19 Updates Newsletter
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
As America shifts to value-based care, it becomes ever more important to get reimbursement claims accurate from the get-go.
by Dave Cardelle and Amy Larsson
Dave Cardelle is VP of Payment Integrity Solution Management at Change Healthcare. Amy Larsson is VP of Clinical Claims Management Solutions at Change Healthcare.
Episode Resources
- Download the Ebook
- Contact Change Healthcare
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
Payment Accuracy is essential to reducing administrative costs, optimizing fee for service, and enabling the transition to value-based care.
by Amy Larsson, VP Clinical Claims Management Solutions, Change Healthcare.
This is part one of a two-part series, focused on trends and best practices in the payment accuracy industry. Part one focuses on How Payment Accuracy Enables the Transition to Value-Based Care. Part two focuses on How Pre-Submission Improves the Provider-Payer Relationship.
Episode Resources
- Download the Ebook
- Contact Change Healthcare
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
Pre-submission of medical claims reduces friction and promotes collaboration between providers and payers.
By Dave Cardelle, VP of Payment Integrity Solution Management, Change Healthcare.
This is part two of a two-part series, focused on trends and best practices in the payment accuracy industry. Part one focuses on How Payment Accuracy Enables the Transition to Value-Based Care. Part two focuses on How Pre-Submission Improves the Provider-Payer Relationship.
Episode Resources
- Download the Ebook
- Contact Change Healthcare
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
Value-based care seeks to improve care quality while reducing cost, and does so, in large part, through the use of innovative alternative payment models. But for payers, transitioning from volume-based payment (i.e., fee-for-service) to value-based alternatives is easier said than done.
On today's show, Mark Berg of McKinsey & Company's Healthcare Innovation group join's Change Healthcare's Rob Capobianco to talk about the steps payers need to take to succeed with value-based care and APMs, and the seven characteristics of successful alternative payment models—the topic of a recent McKinsey report.
Here's what they covered:
- What does McKinsey & Company do and who are their clients (03:47)
- The importance of having organizational systems in place to scale value-based models (07:57)
- Value-based payment as a core strategy for medical cost control, and the role of primary care practices (11:16)
- Value-based care pain points and the importance of stakeholder engagement (18:03)
- How episodes-of-care can help payers develop their value-based strategies (22:24)
- The seven characteristics that make a value-based model successful (27:37)
- How risk shapes success, and how fast or slow to go (32:34)
- When should payers commit to value as a core strategy (34:40)
Episode Resources
- Contact Cappy
- Mark Berg's bio
- The Seven Characteristics of Successful Alternative Payment Models
- Research: Value-Based Care State-by-State
- Seminar: How Anthem is Scaling Value-Based Payment
- Value-Based Payment Resource Hub
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Senator William Frist, a former U.S. Senate Majority Leader and nationally recognized heart and lung transplant surgeon, has launched a new podcast called A Second Opinion. The podcast's mission: rethinking American healthcare. We invited Sen. Frist to join Deanne Kasim, Senior Director of Federal Health Policy Strategy at Change Healthcare, to discuss healthcare innovation, policy, technology, leadership, medicine and, of course, the Senator's new podcast. Here's what they covered.
- Why use a podcast to tackle America’s healthcare problems? (00:56)
- The intersection of public policy, medicine, healthcare, innovation, and entrepreneurship (03:57)
- Defining social determinants of health: what they are and why they’re important (07:24)
- How the Nashville Health initiative determined the top three health issues for the city and how the community is tackling them (10:16)
- The most comprehensive set of data on social determinants of health in the U.S. (14:58)
- Four principles for improving health and wellbeing in a community (19:40)
- Three policy issues Congress must address now (23:58)
- The role of technology to address healthcare access and quality at the intersection of claims and clinical data (30:04)
- Four issues that will play out in the 2020 Presidential election (33:18)
Episode Resources
- Contact Senator Bill Frist, M.D.
- A Second Opinion podcast
- Price Transparency in Healthcare
- Practical Innovation in Healthcare
- 2019 Consumer Insights Report
- 9th Annual Pulse Report
- Value-Based Care State-by-State Report
- Price Transparency is Coming for Payers, Providers, and Pharma. Are You Ready?
- New Thinking for Providers to Reduce Bad Debt by Improving the Patient Experience
- CommonWell Health Alliance Awards Change Healthcare Six-Year Contract to be the Provider of Clinical Interoperability Services
- Change Healthcare to Provide Free Healthcare Data Interoperability Services for all Americans on Amazon Web Services
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- Contact Change Healthcare
Aparna Higgins' career has been focused on value-based payment. More than ten years ago, while she was at Booz-Allen, she co-led the design of the Medicare Hospital Value-Based Purchasing report to Congress. It was one of the first programs recommended to the CMS that defined how hospitals could be assessed and rewarded for care quality. The report’s recommendations were implemented when the CMS was authorized under the Affordable Care Act to implement the program.
More recently, as an executive at AHIP (America’s Health Insurance Plans), Aparna led organizational efforts on payment and delivery system reform, included examining and identifying industry-wide best practices in the design and implementation of Alternative Payment Models (APMs), and the core quality measures collaborative. She’s spent most of her career thinking about incentives, incentive design, and how to assess and reward performance.
These days Aparna is the founder and CEO of Ananya Health Innovations. She’s also a guiding committee member of the Health Care Payment Learning & Action Network, also known as “the LAN,” which was established to accelerate the healthcare system’s transition to alternative payment models. The LAN’s major contribution to the industry is the APM Framework, which provides healthcare stakeholders with a roadmap to understand, design, and assess the adoption of alternative payment models.
We asked Aparna to join us on the podcast to talk about how the APM Framework can help payers and providers achieve their value-based payment goals. On today’s show, we’ll take you through:
- The LAN’s mission and how it created APMs (02:16)
- The roadmap, benchmark, and other tools the LAN created to help payers achieve their VBC goals (06:06)
- A dive into the APM roadmap’s three pillars: APM design, payer/provider collaboration, and patient-centered care (10:20)
- Why having access to better data is better for providers (15:51)
- How payers can support providers, especially smaller providers, in analyzing data and identifying areas to focus on (19:12)
- How payers and providers are changing patient engagement in the real world (21:29)
- Evolving an APM from retrospective to prospective (28:19)
- The importance of outcome-focused measurements (33:09)
- Key tips for payers on advancing their APM programs (35:15)
- What providers need to be successful in APM models (37:00)
- How leadership and organizational culture for both payers and providers is key to success (39:00)
- Aparna’s closing thoughts (40:54)
Episode Resources
- Contact Patrick McGuigan
- Aparna Higgins bio
- The Healthcare Payment Learning & Action Network
- The HCP-LAN APM framework
- Research: Value-Based Care State-by-State
- Seminar: How Anthem is Scaling Value-Based Payment
- Value-Based Payment Resource Hub
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
The Centers for Medicare and Medicaid Services recently launched a new innovation model known as the Comprehensive Primary Cares Initiative (CPCI). The goal of this voluntary multi-payer model is to strengthen the use of and reliance on primary care for all patients, while pushing forward in the progression from fee-for-service to a value-based healthcare system.
The CPCI comprises a new set of payment models designed to transform primary care to deliver higher value for patients throughout the U.S. healthcare system. CMS says the CPCI builds on lessons learned from previous models, and will reduce administrative burdens and empower primary care providers to spend more time caring for patients while reducing healthcare costs.
To help understand this complex but important new CMS program, we invited Dr. Andrei Gonzales, Change Healthcare’s AVP of Product Management for Value Based Payments, to talk about the initiative’s potentially transformative effect on payment and clinical models. In addition to helping improve care quality and reducing cost for CMS members, Dr. Gonzales says this new model can also help improve quality scores and expand opportunities for shared savings.
Covered on today's show:
- What is the CMS Comprehensive Primary Cares Initiative (7:22)
- The timeline for the effect on primary care physicians (17:18)
- What health plans can do now to prepare for the future (20:33)
- Providers’ reactions to the new initiative (22:35)
Episode Resources
- Contact Patrick McGuigan
- Dr. Andrei Gonzales's bio
- CMS Comprehensive Primary Care Initiative
- Research: Value-Based Care State-by-State
- Seminar: How Anthem is Scaling Value-Based Payment
- Value-Based Payment Resource Hub
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
There’s no denying that reducing bad debt is at the top of revenue cycle leaders’ agendas. Patient liability has skyrocketed in recent years due to the rise in high-deductible health plans and erosion in coverage.
And many, if not most providers are being tripped up by these changes. The reason: Existing revenue cycle management practices are out of step with their patients’ new reality. They were never designed to accommodate sudden and dramatically higher patient liability.
The result is bad debt is rising, and the work required to collect it is damaging relationships with patients. But it doesn’t have to be this way. New thinking is emerging around contemporary patient liability management that pairs improvements to the patient experience with reducing denials and bad debt.
We invited two experts on the topic of advanced liability management to join us today on the Change Healthcare podcast: Raghu Bukkapatnam, Chief Strategist for Technology Enabled Services at Change Healthcare; and Bill Krause, VP of Digital Experience and Consumer Engagement at Change Healthcare. On today's show, we cover:
- The consumerization of revenue cycle management (02:59)
- Providers struggling to meet consumer expectations, bad debt rising (6:44)
- The nexus of patient liability, consumer engagement, digital experiences, and collections (10:31)
- Gaps providers can close to reduce bad debt and improve patient relationships (17:29)
- Where the industry falls on the patient liability management continuum (24:55)
- Advice for providers facing resistance to change (28:37)
- Risk and ROI measurement for advanced patient liability management (36:16)
- Time to change: The patient liability management countdown (41:17)
- Examples of successful patient financial experience transformation (46:52)
Episode Resources
- Bio: Raghu Bukkapatnam
- Bio: Bill Krause
- Infographic: How Patient Liability Management Helps Improve the Patient Financial Journey
- Improving the Patient Financial Experience and Maximizing Patient Collections
- Change Healthcare Introduces the First Patient Liability Solution to Help Improve the Entire Patient Journey
- Contact us
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
"Hospital in the Home" is emerging as a frequently discussed concept in the medical community. Programs that allow patients to receive hospital-level of care in their homes have shown to be safer, less costly, and result in better patient outcomes. As a result, Hospital in the Home programs are gaining traction as an alternative option to acute inpatient stays.
To better understand the opportunities, benefits, and challenges of Hospital in the Home programs, we invited two of the nation's pioneers and leading experts on the matter to join us on the Change Healthcare podcast: Dr. Bruce Leff, Director for The Center of Transformative Geriatric Research at Johns Hopkins University School of Medicine; and Dr. Allyson Kreshak, emergency medicine physician and Assistant Medical Director at UC San Diego Emergency Department.
Both helped innovate and steer Hospital in the Home programs for their respective hospital systems,and are optimistic that in-home hospital care can become the new standard of care for some patients. On today's show, we dive deep into the Hospital in the Home trend and discuss:
- The genesis of Hospital in the Home programs and today's modern home-based care movement (5:50)
- The quantifiable (and non-quantifiable) benefits of Hospital in the Home for patient outcomes (11:07)
- What contributes to a successful Hospital in the Home program? (16:41)
- The adoption challenges some Hospital in the Home programs have faced and the role of technology in the future of more streamlined home-based care (20:18)
- Which patients are appropriate for Hospital in the Home programs? (26:18)
- Top considerations to win buy-in to establish a Hospital in the Home program and common pitfalls to avoid (33:50)
- Steps to create internal infrastructure for a successful Hospital in the Home program (33:50)
- The practicalities of reimbursement models (44:00)
- The future of Hospital in the Home (46:12)
Episode Resources
- Bio: Laura Coughlin RN
- Bio: Dr. Leff
- Bio: Dr. Kreshak
- Change Healthcare introduces InterQual 2019
- InterQual evidence-based clinical decision support web
- InterQual 2019 brochure
- Contact us
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
Effective Medicaid engagement strategies encourage member populations to take a more active role in their healthcare. Done well, member engagement can help payers improve population health and plan performance. But that's easier said than done. Indeed, member engagement is one of the biggest challenges faced by plans and providers.
While there's no silver bullet to maximizing enrollee engagement, there are several proven strategies and practices that can help address mitigating factors such as social determinants of health, wellness motivators, and ineffective member communications.
We invited Natalee Fowler, a nationally recognized expert on Medicaid member engagement, to share some of her favorite techniques for helping payers better engage members. Natalie covers the common challenges, unpacks the buzzwords, and provides a roadmap for a contemporary communication strategy that can help payers raise the bar for engagement.
On today’s show, we discuss:
- The biggest challenges to increasing member engagement (00:44)
- Decoding industry buzzwords around member health motivators (03:04)
- Moving the needle on maternal health engagement (05:43)
- Maternal health program communication best practices (09:47)
- Creating relevant content to improve engagement and outcomes (12:43)
- Positioning for success with actionable metrics (15:55)
- Measuring continued member engagement to prevent decline (18:44)
- Do incentive programs really work? (20:26)
Episode Resources
- Contact Change Healthcare
- Change Healthcare Smart Connect & Smart Appointment Scheduling
- How to Drive Better Health Outcomes with Knowledge-Driven Engagement
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
The Wall Street Journal and other leading publications are reporting that plans are afoot in Washington to issue a pricing transparency mandate that will affect how Americans shop for, receive, and pay for healthcare services in America. According to the reporting, the White House is developing a strategy aimed at bending the healthcare cost-curve by giving consumers greater access to healthcare pricing before they receive services.
The mandate is expected to require insurers to publicize the negotiated rates they pay for services, and require hospitals and physicians to provide patients with a "total price for care" before consumers receive services. It builds on a mandate that took effect in January, which required hospitals to post their prices online. The goal: bring greater transparency to the healthcare market for consumers, so they can make better choices.
We asked Bill Krause, VP of Experience Solutions, to help us understand Change Healthcare’s perspective on this news, and on the issues of price transparency and consumer engagement overall. We also asked Bill to share his advice to payers and providers who are following this news and challenged by the increasing "retailization" of healthcare.
On today's show, we discuss:
- The connection between price transparency and value-based care (02:37)
- What healthcare transparency means and the issues it poses to consumers (04:24)
- Why price transparency and consumer engagement are inseparable (08:17)
- What solutions are available today to help payers and providers meet these anticipated requirements (11:38)
- Transparency and consumer engagement innovations Change Healthcare is working on (14:07)
- An update on the Change Healthcare-Adobe-Microsoft partnership (16:28)
- What the retailization of healthcare means for payers, providers, and patients (18:43)
- What payers, providers, and employers can do immediately to help move the needle on price transparency and consumer engagement (23:00)
Episode Resources
- Contact Bill Krause
- Price Transparency in Healthcare
- Practical Innovation
- Change Healthcare 2019 Consumer Insights Report
- Change Healthcare True View
- Change Healthcare Patient Access Suite
- Change Healthcare Clearance Estimator
- Change Healthcare Clearance Authorization
- MDsave website
- Change Healthcare makes strategic investment in MDsave
- Change Healthcare partners with Adobe and Microsoft
- Wall Street Journal: White House wants patients to know healthcare prices up front (5/15)
- Wall Street Journal: Trump administration preparing executive order on health-cost disclosure (5/24)
Show Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
Today, over 12 million individuals are enrolled in both Medicaid and Medicare. These “dual eligible” individuals typically have high rates of chronic illness, many with multiple chronic conditions and/or social risk factors.
In a recent letter to state Medicaid directors, the Centers for Medicare and Medicaid services (CMS) outlined ten opportunities to better serve dual eligible populations. These opportunities are the result of new developments in managed care, Medicare data sharing, and reducing administrative burden for dual-eligibles and their providers.
CMS is encouraging states to take advantage of these opportunities to create more seamless experiences for dual-eligibles and to improve how both the Medicare and Medicaid programs work together.
In this edition of Episode Intelligence, Vicki Jessup, director of government relations for Change Healthcare, shares insights into what the opportunities outlined by CMS mean to states, health plans, and their members with Keslie Crichton, VP of sales for Change Healthcare’s member engagement and dual eligible solutions.
In today's show they discuss:
- How the opportunities outlined by CMS impact Medicare Advantage plans and members (02:10)
- How more frequent data exchange improves coverage and payment accuracy (04:37)
- The meaning of and opportunities surrounding Medicare Part A buy-in enrollment (08:33)
- How some states are simplifying eligibility and enrollment for Medicare savings programs (12:11)
Related Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Change Healthcare Fuses Artificial and Human Intelligence for Medicare Advantage Dual Eligibility and Enrollment
- Blending AI and Behavioral Science to Improve Dual Eligibility Advocacy
- Dual Enrollment and Recertification
- Dual Enrollment Advocate™ & Recert Complete®
- The State of Value-Based Care in 2018
- Value-Based Care in America: State by State
- Suggest or become a guest
Blockchain offers significant potential for transforming healthcare processes, but few concepts have moved from just a vision to a stage where true benefits can be realized. That’s about to change. At HIMSS, Change Healthcare will be introducing a new Payments Blockchain proof-of-concept (PoC) which was developed by our provider payments team. The re-engineered payment process is powered by a distributed ledger, and is designed to reduce the disparate entries that exist in today’s disconnected and legacy payment processes. The Payments Blockchain PoC kicks open the door for a streamlined, smart, and secure payment process that payers and providers can only dream about today.
On today’s show, we interview the Change Healthcare and Digital Asset team that’s come together to build this new Payments Blockchain. On the panel: Gopi Devalcheruvu, the vice president of technology for Change Healthcare; Vinod Nair, the director of product management for Change Healthcare; and Dan O’Prey, chief marketing officer for Digital Asset. Listen now to hear what this group of experts has to say about blockchain for healthcare. The panel discusses:
- The backstory and development of the Payments Blockchain proof-of-concept
- How the Payments Blockchain works
- What the future of healthcare payment might look like
- Predictions for the evolution of blockchain in healthcare
- The payment blockchain’s potential for encouraging a wave of new capabilities for payers, providers, and partners
- How the Payments Blockchain is enabled by the Change Healthcare payment network
Related Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Infographic illustrating the Payments Blockchain process
- Change Healthcare facts (contains the metrics referenced in the podcast)
- Change Healthcare website
- Digital Asset website
- DAML website
- Suggest or become a guest
It’s no secret that healthcare costs are out of control for consumers. But what can get lost in the shuffle is how these costs affect employers, who want their employees to be covered with better healthcare.
Some could argue that healthcare cost-containment is one of the most important pillars of the healthcare equation, and that employers can be a key factor in bending this cost curve. Yet it’s worth noting that since 2013, premiums for employer-sponsored healthcare coverage for families have escalated more than 22%, to reach almost $20,000 per year on average.
This upward trend has renewed interest from employers in alternative payment models. The nonprofit Catalyst for Payment Reform (CPR), which provides guidance into the efforts of employers to drive increased healthcare value, is helping close that gap. And as some companies now opt to go directly to providers—bypassing health plans and cutting out the middleman—they certainly could benefit from an expert perspective.
In this edition of Episode Intelligence, we spoke with CPR Executive Director Suzanne Delbanco, who expanded on her organization’s work with Rob Capobianco, Change Healthcare VP of Value Based Payments.
In today's show they discuss:
- How working to promote payment reform is a means of improving healthcare value (01:08)
- How payment reform progress is measured (04:41)
- What healthcare purchasers want from their health plans (11:40)
- The transition from fee-for-service and progress of bundled payments (15:05)
Related Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- The State of Value-Based Care in 2018
- Suggest or become a guest
Representatives from CMS just announced a policy shift regarding mandated alternative payment models.
HHS Secretary Alex Azar said the administration would “revisit” mandatory models that it had previously abandoned in cardiac care, noting the time had come for “exploring new and improved episode-based models in other areas, including radiation oncology.”
To understand the impact this policy shift might have on payers and providers, Patrick McGuigan, Producer of Episode Intelligence, connected with Dr. Andrei Gonzales, who leads the product development efforts for Change Healthcare’s value-based payment solutions.
In this interview, they discuss:
- What CMS is introducing and why it’s generating so much news [00:23]
- What this means for commercial health plans [02:40]
- What health plans should be doing now to prepare for this change [04:46]
- How providers are reacting to this news, and how they can prepare for a future that includes mandatory payment models [06:03]
Related Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
Primary care physicians (PCPs) are in the best position to coordinate patient care, because they understand their patients' unique needs. But knowing which specialists can deliver the most effective care when a referral is required can challenge even the most experienced PCP.
That's because PCPs rarely have insight into the costs and quality of care delivered by other providers. Lacking this evidence, they have no alternative but to base referrals on personal experience, professional recommendations, doctor ratings, and patient requests.
This is changing, however, thanks to a new approach called “episode intelligence.” Using HIT analytics, episodes of care are analyzed to identify physicians and facilities that can deliver the most effective care throughout a course of treatment.
One innovative organization using episode intelligence is Tandigm Health, a value-based healthcare company supporting primary care physicians. Heading Tandigm’s effort is Director of Informatics Tony Tedesco, an early adopter of the technology. Tedesco is using it to help PCPs improve patient referrals, measurably helping them deliver higher quality care at a lower cost.
In this interview, Tedesco talks about:
- How and why Tandigm is using episode intelligence to put primary care physicians back in charge of patient care
- The primary care physician's evolving role in coordinating comprehensive care
- How episode intelligence improves utilization of specialists, which leads to higher-value care
Related Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- The State of Value-Based Care in 2018
The rise of value-based care and the ongoing evolution of healthcare technology are just two of the many topics the new CEO of America’s Health Insurance Plans (AHIP) says are front and center on his upcoming agenda.
AHIP’s Matt Eyles takes a deep dive on those subjects and more while speaking with Rob Capobianco, the head of the Change Healthcare value-based-care analytics team, as part of the Change Healthcare Episode Intelligence podcast series.
Matt has more than two decades of healthcare experience in both the private sector and in government. Before joining AHIP, he held senior executive positions at Coventry Health Care, Inc., and Wyeth, and has been a consultant to some of the largest global and U.S. healthcare companies and organizations.
Matt began his career at the Congressional Budget Office where he worked on many issues, including healthcare, budget policy, and regulatory policy.
Rob and Matt cover a wide range of topics, including:
- The biggest differences in healthcare policy Eyles has seen in the past ten years
- Short- and long-term priorities for AHIP
- The future of value-based care
- The healthcare technology evolution
Related Resources
- SUBSCRIBE to the podcast using any podcatcher or RSS reader
- Download the audio and listen offline
- Get the iOS app
- Get the Android app
- Suggest or become a guest
- The State of Value-Based Care in 2018
- Value-Based Reimbursement State-by-State
- HealthQx Provides Customers the Keys to Cloud Security