Managed care

AHF Prevails in CA’s Unconstitutional Attempt to End Medi-Cal Contract

Retrieved on: 
Friday, March 22, 2024
Professional Services, AIDS, Health, Legal, Insurance, Health Insurance, General Health, AIDS Healthcare Foundation, District court, Patient, Managed care, DHCS, Constitutional right, AHF, State, Medi-Cal, Hospital

In a move that ultimately was found unconstitutional, the State and its representatives attempted to end AHF’s very long-standing Medi-Cal contract to provide health care to about 770 people living with AIDS in California after AHF mailed patients suggesting they contact DHCS.

Key Points: 
  • In a move that ultimately was found unconstitutional, the State and its representatives attempted to end AHF’s very long-standing Medi-Cal contract to provide health care to about 770 people living with AIDS in California after AHF mailed patients suggesting they contact DHCS.
  • AHF sued, alleging violations of the First Amendment, and the court issued a preliminary injunction.
  • The lawsuit was pursued in the U.S. District Court, Central District of California (Los Angeles), and the U.S. Court of Appeals, Ninth Circuit.
  • The dispute is now over, and AHF’s contract has been further extended through December 31, 2025.

Decisiv and TICO Build on their Foundation of Connected Service

Retrieved on: 
Monday, March 4, 2024
Sentinel, SRM, TICO, Booth, Ernest, Communication, Exhibition, TMC, Combat support, Managed care, Partnership

RESTON, Va. and NEW ORLEANS, March 4, 2024 /PRNewswire-PRWeb/ -- Decisiv, Inc., the industry leader in Service Relationship Management (SRM) solutions, announced here at the TMC 2024 Annual Meeting & Transportation Technology Exhibition, an expanded partnership with terminal tractor manufacturer TICO to add the Decisiv SRM Sentinel Managed Care application to the TICO Edge platform.

Key Points: 
  • "With Decisiv SRM Sentinel incorporated in TICO Edge, our dealers will have the ability to proactively manage upcoming service needs for their customers' assets and improve uptime.
  • The addition of SRM Sentinel builds on the 2020 introduction of TICO Edge, powered by Decisiv SRM.
  • The Decisiv SRM platform allows the manufacturer's dealer network, customers, and the TICO Uptime Center to communicate and collaborate, and have real-time visibility, into service and repair events.
  • This latest connected service initiative continues to set TICO apart from other manufacturers and their service networks."

TRIUNE Health Group grows by integrating Advanced Disability Management

Retrieved on: 
Monday, February 5, 2024
Health administration, Nursing, ADM, Wellness, Injury, Managed care, Alternative medicine, Case management, Health care, Workforce, Workers' compensation

LOMBARD, Ill., Feb. 5, 2024 /PRNewswire-PRWeb/ -- TRIUNE Health Group and Advanced Disability Management (ADM) are excited to announce the integration of their two privately owned Managed Care companies, effective immediately.

Key Points: 
  • TRIUNE Health Group and Advanced Disability Management (ADM) are excited to announce the integration of their two privately owned Managed Care companies, effective immediately allowing TRIUNE to expand their coverage in California.
  • LOMBARD, Ill., Feb. 5, 2024 /PRNewswire-PRWeb/ -- TRIUNE Health Group and Advanced Disability Management (ADM) are excited to announce the integration of their two privately owned Managed Care companies, effective immediately.
  • In 2024, TRIUNE Health Group will celebrate 34 years of providing industry-leading service and solutions to employee health care management.
  • TRIUNE Health Group is an industry expert in Health Care Management.

Unlock Health Appoints Kevin Thilborger as Chief Managed Care Officer and Chief Revenue Strategy Officer

Retrieved on: 
Wednesday, January 24, 2024
Philosophy, Spring Hill College, Federal Medical Centres, Insurance, Tulane University, Communication, Growth, Health, Marketing, Managed care, Humana, Health administration, ROI, Management

NASHVILLE, Tenn., Jan. 24, 2024 /PRNewswire/ -- Unlock Health, a healthcare technology and services growth platform for providers and fast-growing digital health organizations, today announced the appointment of Kevin Thilborger as Chief Managed Care Officer and Chief Revenue Strategy Officer. In his new role, Kevin will spearhead the Managed Care Consulting arm of Unlock Health, overseeing all aspects of the practice, including care delivery insights, reimbursement strategy, digital transformation, and communication. He will also contribute his expertise to the advisory councils for new strategic investments within the firm.

Key Points: 
  • Thilborger's appointment reflects Unlock Health's commitment to bringing together technology,
    NASHVILLE, Tenn., Jan. 24, 2024 /PRNewswire/ -- Unlock Health , a healthcare technology and services growth platform for providers and fast-growing digital health organizations, today announced the appointment of Kevin Thilborger as Chief Managed Care Officer and Chief Revenue Strategy Officer.
  • In his new role, Kevin will spearhead the Managed Care Consulting arm of Unlock Health, overseeing all aspects of the practice, including care delivery insights, reimbursement strategy, digital transformation, and communication.
  • "The concept of combining technology, revenue strategy, and marketing to drive growth and revenue for healthcare is so intriguing because it has never existed in a single organization before Unlock Health.
  • "This was a strategic hire as Kevin provides the necessary leadership and expertise Unlock Health needs to connect the dots between technology, managed care and marketing."

Abacus Insights Appoints New Independent Board Director

Retrieved on: 
Tuesday, October 31, 2023
Professional Services, Health, Health Technology, Insurance, Health Insurance, General Health, Knowledge, TCO, Goldman Sachs, MacIvor, Medicare, HITRUST, Abacus, MD, Oxford Health Plans, Managed care, Ernst, Trustee, Fellowship hall, Insight, Health care, Management, Young, UnitedHealth Group

Abacus Insights , the leader in data usability for U.S. healthcare payers, is pleased to announce that it has added William McIvor to its board of directors.

Key Points: 
  • Abacus Insights , the leader in data usability for U.S. healthcare payers, is pleased to announce that it has added William McIvor to its board of directors.
  • “Bill’s operational and strategic leadership at the innovative intersection of payers, providers and technology brings a wealth of knowledge and know-how to Abacus Insights’ mission of improving healthcare by making data usable,” said Minal Patel, MD, founder and CEO of Abacus Insights.
  • Abacus Insights’ data usability solutions dramatically increase our payer partners' ability to dynamically and responsively meet strategic goals,” McIvor said.
  • He will be Abacus Insights’ first independent director.

Humana Kentucky Medicare Advantage HMO Plan Scores Top 5-Star Rating Third Year in a Row

Retrieved on: 
Saturday, October 14, 2023
General Health, Health, Professional Services, Insurance, Health Insurance, Centers for Medicare & Medicaid Services, NYSE, St. Elizabeth Healthcare (Kentucky), HMO, Managed care, CMS, Medicare, Health insurance, Nursing, Humana

The Humana Health Plan of Ohio, Inc. HMO plan is one of four Humana contracts that received a 5-star rating for 2024 on CMS’s 5-star rating system.

Key Points: 
  • The Humana Health Plan of Ohio, Inc. HMO plan is one of four Humana contracts that received a 5-star rating for 2024 on CMS’s 5-star rating system.
  • Another one of Humana’s four top-rated contracts received the 5-star rating for the first time, adding a new Kentucky county to the list; the Humana Medical Plan Inc. HMO plan is offered in Jefferson County.
  • Combined, the four 5-star contracts cover approximately 790,000 Humana members nationwide, more than double the number of members in 5-star plans in 2023.
  • “I appreciate how Humana really wants us to be the healthiest version of ourselves and provides us with resources to accomplish that,” Nancy said.

Redefining Homecare Excellence: Sandata Technologies Leads with Innovative Pre-Adjudication Claims Management Solution

Retrieved on: 
Tuesday, October 3, 2023
Public Policy, Government, Software, Insurance, General Health, Health, Healthcare Reform, Professional Services, Technology, MCO, Medicaid, Ecosystem, EVV, Friction, EDI, Fraud, Partnership, Electronic visit verification, Managed care, Cryptocurrency, Sandata

In a transformative move to fortify the integrity and efficiency of homecare services and claims payment, Sandata Technologies proudly unveils a powerful pre-adjudication claims editing solution that streamlines and automates the intricate process of managing homecare claims.

Key Points: 
  • In a transformative move to fortify the integrity and efficiency of homecare services and claims payment, Sandata Technologies proudly unveils a powerful pre-adjudication claims editing solution that streamlines and automates the intricate process of managing homecare claims.
  • Sandata’s strategic innovation is set to ensure payment accuracy, reduce provider friction, and elevate overall efficiency in the homecare ecosystem.
  • Sandata harnesses enhanced claims editing capabilities and a partnership with the nation's leading clearinghouse to seamlessly integrate, inspect, and validate care plans, authorizations, visit details, and claims.
  • "With this release, Sandata reaffirms our commitment to reshaping the future of homecare by strengthening connections between payers and providers," asserts Emmet O’Gara, CEO of Sandata.

XiFin Launches New Lab Volume Index (LVI): Delivers Deeper Insights in Post-Pandemic Diagnostic Testing

Retrieved on: 
Wednesday, August 30, 2023
Software, Practice Management, Telemedicine, Virtual Medicine, General Health, Health, Artificial Intelligence, Health Technology, Technology, UBS, Workflow, RCM, Pathology, Prenatal testing, Intelligence, Multimedia, COVID, Managed care, Holiday, Investment, Laboratory, Webcast, Engineering, Pain management, Toxicology, Genetic testing, Internationalized domain name, NYSE, LVI, Microbiology, Cryptocurrency, Pharmaceutical industry

The LVI insights and trends are derived from claims transaction data from within the award-winning XiFin RPM platform .

Key Points: 
  • The LVI insights and trends are derived from claims transaction data from within the award-winning XiFin RPM platform .
  • For example, if the Lab Volume Index is selected for molecular and genetic, it shows the testing volume of all molecular and genetic testing, irrespective of whether it was performed at a hospital lab, a clinical lab, one that primarily does pain management and toxicology, or a lab specializing in molecular testing.
  • The enhanced XiFin Lab Volume Index also features a new user-selectable baseline for 2019 -2022, making it possible to compare the time going forward including annually.
  • Because the COVID volume is historically significant, the original XiFin Lab Volume Index was measured weekly to trend the surges and lulls that happened quickly during the pandemic.

Following a Successful Commercial Launch, Intuition Robotics Raises $25M in Additional Funding

Retrieved on: 
Tuesday, August 29, 2023
LLM, Loneliness, Prevalence, Life, Friends, Intuition, Managed care, Synthetic media, Ageing, Government, Creativity, OurCrowd, Woven fabric, Medicare, New York State Office of Children and Family Services, GAN, Robotics, Risk, Heel, Generative, Growth, AI, Health, Death, Smoking, Family, Legislation, 3D printing

RAMAT GAN, Israel, Aug. 29, 2023 /PRNewswire/ -- Intuition Robotics announced today that it has secured a first closing of a new funding round amounting to $25 million, $20M in venture capital and $5M in venture debt, and led by Woven Capital, the growth fund of Toyota, with participation from Toyota Ventures, OurCrowd, Western Technology Investment, and additional investors. The funding will help the company meet surging demand for its AI care companion ElliQ across government aging agencies and healthcare organizations. It will also allow the company to deepen integrations into the healthcare system and help aging populations better connect with others, and better access much-needed products and services while reducing costs.

Key Points: 
  • The funding will help the company meet surging demand for its AI care companion ElliQ across government aging agencies and healthcare organizations.
  • Surgeon General recently advising that experiencing loneliness can increase the risk of death equivalent to smoking 15 cigarettes a day.
  • Intuition Robotics has pioneered ElliQ , an AI companion designed to enhance the lives of older adults by combating loneliness and promoting healthy and independent living.
  • The funding round comes on the heels of a successful commercial launch with government agencies across the United States.

U.S. Consumer Out-of-Pocket Healthcare Spending to Grow 10% Annually Through 2028, forecasts Kalorama Information report

Retrieved on: 
Tuesday, July 25, 2023
Government, Medication, Managed care, COVID-19, Policy, Information, Growth, OOP, Ageing, Obesity, OTC, Health insurance

ARLINGTON, Va., July 25, 2023 /PRNewswire-PRWeb/ -- Out-of-pocket expenditures (OOP) have long weighed upon the United States healthcare system and consumers. The weight is as heavy as ever in 2023 as OOP healthcare spending by consumers will reach an estimated $519 billion by year's end, up almost 9% from 2022 with continued annual growth of 10% forecast through 2028. These findings are based on new data featured by leading medical market research firm Kalorama Information in the July 2023 report Out of Pocket Spending in Healthcare (Pharmaceuticals, Surgeries, Tests, Electives, Premiums, Copays, Doctor Visits, Other), 6th Edition.

Key Points: 
  • Kalorama Information has published a new report that estimates U.S. consumer out-of-pocket spending on healthcare, particularly direct payments to providers and financed payments between 2020-2028.
  • ARLINGTON, Va., July 25, 2023 /PRNewswire-PRWeb/ -- Out-of-pocket expenditures (OOP) have long weighed upon the United States healthcare system and consumers.
  • These findings are based on new data featured by leading medical market research firm Kalorama Information in the July 2023 report Out of Pocket Spending in Healthcare (Pharmaceuticals, Surgeries, Tests, Electives, Premiums, Copays, Doctor Visits, Other), 6th Edition .
  • While the COVID-19 pandemic of 2020 and 2021 caused a temporary pullback in consumer out-of-pocket healthcare spending, the historic trend resumed in 2022, initiating the current growth trajectory.