What are payer insights? A health plan guide to better data-driven decisions
Health plans have access to more data than ever before. Claims, clinical records, provider information, quality measures, financial results, member demographics, and operational reports all contain useful signals. The challenge is that these signals are often spread across systems, teams, and reporting processes. Health plan leaders know that data holds the key to understanding cost, … What are payer insights? A health plan guide to better data-driven decisions
What to look for in ACO healthcare software: A buyer’s guide
Choosing accountable care organization (ACO) healthcare software is often handled as a procurement exercise, but the decision shapes how clearly your organization understands its financial position for years afterward. The quality of that decision is difficult to judge from a vendor demonstration, because most value-based care (VBC) software presents a similar front end: attributed lives, … What to look for in ACO healthcare software: A buyer’s guide
HEDIS MY 2027: Key Changes healthcare organizations need to know
The National Committee for Quality Assurance (NCQA) has announced several upcoming changes to the Healthcare Effectiveness Data and Information Set (HEDIS®) that will influence how organizations measure, report, and improve quality of care.1 For Measurement Year (MY) 2027, these updates reflect emerging clinical priorities, advances in technology, and the healthcare industry’s continued shift toward digital … HEDIS MY 2027: Key Changes healthcare organizations need to know
What is risk adjustment software? A guide for healthcare organizations
Risk adjustment depends on accurate data, complete documentation, and consistent workflows. For healthcare organizations managing risk-based contracts, those requirements can become difficult to coordinate across teams, systems, and populations. Claims data may live in one place, clinical data in another, documentation review in a separate workflow, and reporting in static dashboards or spreadsheets. Risk adjustment … What is risk adjustment software? A guide for healthcare organizations
Signs your organization needs better clinical and claims data integration
Almost no healthcare organization intentionally builds a fragmented data environment. Fragmentation develops through reasonable decisions: an acquired practice arrives with a second EHR instance, a risk-based contract introduces another payer file, a vendor relationship brings in laboratory or pharmacy feeds. Their combined effect is a set of systems describing the same patients and members differently. … Signs your organization needs better clinical and claims data integration
How to choose the right risk adjustment vendor
Executive Summary Choosing a risk adjustment vendor should never be reduced to coding function alone. The right platform should improve documentation quality, integrate into clinical and operational workflows, provide transparent analytics, support prospective and retrospective programs, and maintain audit readiness. Organizations should prioritize configurable technology, explainable AI, strong governance, measurable outcomes, and an implementation approach … How to choose the right risk adjustment vendor
