Description: This article focuses on the recent surge of digital medicine data being seen in the healthcare industry. While an increase in data can generally be perceived as good, it is important to remember that current privacy practices need to be maintained, if not strengthened, to continually protect healthcare members. The COVID-19 pandemic helped fuel digital medicine data, but it also created new avenues for privacy to potentially be compromised (i.e. healthcare employees using personal devices while working from home). Digital medicine data is a very powerful asset, but it is also a massive responsibility. If mishandled, this data can cause more harm than good.

Description: The article explores how integrating AI into insurer apps can address critical challenges in healthcare, such as patient no-shows, medication adherence, and cost management. These non-disruptive approaches aim to increase the effectiveness of patient interventions and improve medication adherence.

Description: The heathcare academic literature seems to be saturated with articles on technology. This paper presents summaries of several articles that are intended to be representative, covering a wide range of topics relating to the impact of technology on the healthcare system.

Description: This session series is sponsored by Zelis Shifting utilization of health services to efficient and high-value providers presents an opportunity to reduce harmful cascades of wasteful spending, ultimately freeing up funds for additional high-value services that will improve quality and member satisfaction. Identifying the right providers to put at the center of networks is challenging for any health care organization. How can you objectively determine which providers are delivering the greatest value when compared to their peers? And once those providers are identified, what’s next? Join Zelis and their partner HealthCorum to review a case study on a shared services organization where they leveraged statewide multi-payer claims data to produce provider level analytics, allowing for transparency into provider practice patterns at a granular level. By attending this session, you will be able to: - Create a fair methodology to benchmark providers. - Develop metrics and scores to identify high-value providers. - Produce actionable data to be used for network optimization strategies.

Description: Telehealth enables the delivery of health care services to patients that are not in the same location as providers. Over the past decade, telehealth has been used increasingly to complement face-to-face patient encounters, and is particularly important to addressing health care needs in rural areas. Recent regulatory catalysts, particularly in the Medicare Advantage program, have served to elevate the visibility and importance of telehealth in the overall health care delivery system. Starting in 2020, Medicare Advantage plans can offer any clinically appropriate physician services through telehealth as part of the standard Medicare benefit. Network adequacy standards can also be met via telehealth providers under certain programs. This presentation will cover the basics of what constitutes telehealth, and provide tangible demonstrations of telehealth technology (simulating variations mediums through which services are delivered). We will cover the what, the why, and the where (anywhere) of telehealth in 2020.

Description: CMS provides ACOs with monthly claims data for members, including their medical visits and ACO program eligibility. This data can be divided into Membership and Claims tables through the ETL process. However, when calculating PMPY at specific levels of detail using these tables, issues arise due to unrelated dimensions, leading to inaccurate and understated results. This article presents a solution to this problem by utilizing Tableau's data blending capabilities.

Description: Principal Analyst Laurie M. Orlov of the Aging in Place Technology Watch will present a roadmap for the technology and ITSS marketplace. She will explore where it has been, what it does best, where it is going, and the challenges it faces. She has been a leading researcher and independent analyst in this field for more than 20 years.

Description: Come explore an in-depth overview of telehealth to set context and navigate the continuing expansion of telehealth and its integration into the healthcare delivery system. You will examine the forces that shape telehealth offerings and expect a view of the possible futures of this evolving modality.

Description: As the insurance industry continues to evolve due to a pandemic and rapidly changing economic and regulatory conditions, the role of data scientists and actuaries has become increasingly important. In an interview with the Atidot data science and actuarial team, we discuss what it is like to work at an InsurTech, how data scientists and actuaries can collaborate, and look at some concrete technical examples of where the innovation is having an impact. This article explores what collaboration can look like and how the role of data science and actuary may evolve in the InsurTech industry in the future.

Description: This session series is sponsored by Zelis Claim analytics produces valuable insights about provider cost, quality, and referral patterns. Provider networks can be created around high-value providers to improve clinical outcomes while lowering the cost of care. Programs to improve provider performance and/or incentivize members to choose high-value providers exist, but how do you bring all of this together to achieve desired outcomes? Join us to learn how to leverage provider level analytics to build and optimize a network with high-value providers at the center. Analyze the network for competitiveness and adequacy and demonstrate progress toward network cost saving goals to key stakeholders by modeling claim data for a member population. Finally, ensure the success of your network through an incentive program that shifts utilization to those high performing providers. By attending this session, you will be able to: - Build a realistic provider network with high-value providers at the center. - Evaluate the overall financial impact of network build and optimization efforts. - Learn about an innovative member incentive program.