Wed.Nov 15, 2023

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UnitedHealth sued over use of algorithm to deny care for MA members

Health Care Dive

The lawsuit alleges UnitedHealth used nH Predict to deny claims for Medicare Advantage seniors, despite the algorithm’s determinations being overturned in more than 90% of appeals.

Medicare 363
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Primary care player Forward unveils AI-based, self-serve CarePods backed by $100M investment

Fierce Healthcare

Primary care player Forward unveiled this week what it has been quietly working on the past two years—self-serve CarePods that use artificial intelligence to screen and diagnose health conditions.< | Primary care player Forward unveiled this week what it has been quietly working on the past two years—self-serve CarePods that use artificial intelligence to screen and diagnose health conditions.

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Senate subcommittee signals support for permanent telehealth flexibilities

Health Care Dive

But witnesses noted Congress shouldn’t wait to enshrine pandemic-era accommodations for virtual care, arguing regulatory uncertainty is a danger to telehealth’s longevity.

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UnitedHealthcare hit with class action over alleged use of AI to deny Medicare Advantage claims

Fierce Healthcare

UnitedHealthcare is facing a potential class action lawsuit following allegations that it used an algorithm to deny claims for post-acute care services in Medicare Advantage. | UnitedHealthcare is facing a potential class action lawsuit following allegations that it used an algorithm to deny claims for post-acute care services in Medicare Advantage.

Medicare 355
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From Diagnosis to Delivery: How AI is Revolutionizing the Patient Experience

Speaker: Simran Kaur, Founder & CEO at Tattva Health Inc.

The healthcare landscape is being revolutionized by AI and cutting-edge digital technologies, reshaping how patients receive care and interact with providers. In this webinar led by Simran Kaur, we will explore how AI-driven solutions are enhancing patient communication, improving care quality, and empowering preventive and predictive medicine. You'll also learn how AI is streamlining healthcare processes, helping providers offer more efficient, personalized care and enabling faster, data-driven

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New rule requires nursing homes to disclose ownership

Health Care Dive

The final rule comes in response to growing concerns about the role of private equity firm ownership in nursing homes.

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Digital pharmacy startup Truepill confirms hackers accessed health data for 2.3M users

Fierce Healthcare

Postmeds, doing business as Truepill, confirmed that hackers accessed the personal data of more than 2.3 million patients. | Postmeds, doing business as Truepill, confirmed that hackers accessed the personal data of more than 2.3 million patients.

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Pediatric telehealth startup Summer Health expands text-based service into primary care for kids

Fierce Healthcare

Summer Health launched a year ago as a text-based service for parents to get answers to urgent needs from pediatricians. | There is a growing shortage of pediatric clinicians. To meet the demand for primary care services, Summer Health rolled out a new on-demand text message service for parents to connect with pediatricians, sleep coaches and lactation experts.

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Centene names new COO following leadership turnover

Health Care Dive

Current SVP Susan Smith will take the reins as the health insurer’s chief operating executive starting next year.

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Where social work, tech and health equity intersect

Healthcare It News

Felisha Norrington, director of academic assistance at GSU's College of Nursing and Health Professions, says while there is movement on health equity, social work and technology investments help ensure care resources are accessible to all people.

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Amazon’s One Medical partners with employer group for primary care

Health Care Dive

The primary care chain will serve as a virtual and in-person primary care provider for companies like Coca-Cola, Boeing and JPMorgan.

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How to Make The Best Benefits Decisions for 2025's Workforce: An HR and Total Rewards Guide

Speaker: Kaitlin Ruby Carroll

Retaining top talent in 2025 means rethinking benefits. In a competitive job market, fertility benefits are more than just offerings - they are a commitment to your team’s well-being. Gain critical insights into the latest fertility benefits strategies that can help position your organization as an industry leader. Our expert will explore the unique advantages and challenges of each model, share success stories from top organizations, and offer practical strategies to make benefits decisions tha

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CommonSpirit opens its fiscal 2024 with $441M operating loss, $738M net loss

Fierce Healthcare

CommonSpirit Health marked the first quarter of its 2024 fiscal year with a $441 million operating loss (-5.1% operating margin) and $738 million net loss due to inflation-boosted expenses and stru | Noting the lessened year-over-year losses when normalizing for a yet-to-be-approved provider fee program, the Catholic giant acknowledged "significant industry and economic headwinds" but said it's made progress on financial stability.

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What are the MIPS 2024 Final Scoring Policy Updates? (Part III)

p3care

[ Note: P3 Care, as a MIPS qualified registry, presents your series of blogs on MIPS final rule updates for CY 2023. So, this is ‘ Part III ’ of our CY 2024 MIPS policy changes.] MIPS reporting rules and policies may vary from one reporting option to another. The PFS final rule for MIPS 2024 addresses the changes for all three reporting options briefly.

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CMS finalizes rule requiring greater transparency for nursing home ownership

Fierce Healthcare

The Centers for Medicare & Medicaid Services (CMS) has finalized a rule that will require more transparency into nursing home ownership. | The Centers for Medicare & Medicaid Services has finalized a rule that will require more transparency into nursing home ownership.

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Combating Antimicrobial Resistance in Argentina: Legislation for the Future

CDC

Argentina’s Ministry of Health is implementing the first legislation in South America using a One Health framework to combat antimicrobial resistance (AR), representing Argentina’s commitment to combating AR. Argentina is also participating in CDC’s Global Action in Healthcare Network (GAIHN) to strengthen the capacity to detect, prevent, and respond to AR.

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Why Every Small Business Needs an HCM Solution: A Comprehensive Guide

Managing HR tasks like payroll, compliance, and employee data can overwhelm small businesses. That’s where a Human Capital Management (HCM) solution comes in. Our eBook, Why Every Small Business Needs an HCM Solution: A Comprehensive Guide , shows how an HCM system automates tedious processes, ensuring your business stays compliant and efficient. You’ll learn how to simplify payroll, eliminate costly errors, and empower your employees with self-service tools.

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House of Representatives passes bipartisan funding stopgap that punts DSH cuts, extends other healthcare programs

Fierce Healthcare

The House of Representatives passed a “two-step” spending bill Tuesday that, along with delaying a government shutdown, bumps back pay cuts for hospitals and extends community health center and tra | The "two-step" spending bill, which has already picked up support from the Senate and White House, sets up a mid-January deadline for several healthcare funding priorities.

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Drug approval times around the world

Healthcare ECONOMIST

How long does it take different countries/regions to approve new medications? The US is the fastest and Europe is the slowest among selected major pharmaceutical markets according to a report by EFPIA. Moreover, while a majority (7 out of 10) of therapies in the US rely on expedited approval, in Europe less than 1 in 10 are approved via these pathways.

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Centene taps former Humana exec as new chief operating officer

Fierce Healthcare

Centene taps former Humana exec as new chief operating officer pminemyer Wed, 11/15/2023 - 14:45

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Operating Conditions Worsen As CMS Continues To Gaslight Home Health Providers

Home Health Care

The final payment rule reaffirmed that, no matter the amount of on-the-ground testimonial or data the home health industry lays out, the U.S. Centers for Medicare & Medicaid Services (CMS) is going to continue gaslighting providers. CMS has a hard job, and protecting the Medicare trust fund is a noble cause. But with each proposed and final payment rule over the last few years, it has continued to deal blows of uncertainty and distress to a group of health care providers that can actually po

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Best Practices to Streamline Compensation Management: A Foundation for Growth

Speaker: Joe Sharpe and James Carlson

Payroll optimization can be one of the most time-consuming and complex factors of small business management. Yet, organizations that crack the code on streamlining employee compensation often discover innovative avenues for growth. With the right strategies in place, outsourcing and streamlining payroll processes can result in substantial time and resource savings.

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Healthcare Worker Vaccination is Important for Respiratory Virus Season

CDC

Respiratory virus season is here. As a healthcare worker, you play a critical role in slowing and preventing the spread of viral respiratory infections, including flu and COVID-19. Like hand hygiene, personal protective equipment (PPE), and environmental cleaning and disinfection, vaccination is a critical tool in our infection control toolbox. Getting recommended vaccines in combination with implementation of these infection control best practices can help protect you and others in your healthc

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Humana’s Plans For Value-Based Care, Home Health M&A

Home Health Care

Over the years, Humana Inc. (NYSE: HUM) has been vocal about prioritizing value-based care. On Wednesday, it released its annual “Value-Based Care Report,” which affirms why its been crucial to the company’s Medicare Advantage (MA) beneficiaries. Overall, MA members who are getting care through value-based arrangements received more time with their primary care physician.

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Reducing the Stigma of Addiction

GoMoHealth

Deena Cohen, MPA, CADC, CTTS, WTS Director of Community Programs, GoMo Health In a world that is becoming increasingly aware of mental health disorders, one area still shrouded in darkness is the stigma surrounding substance use disorder (SUD). This stigma not only affects those struggling with addiction but also hampers efforts to provide effective support and treatment.

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More Providers See CCRC-At-Home Models As The Right Offering For Middle-Class Consumers

Home Health Care

Ten years ago, Lisa Hoffman — the executive director of Pathstones by Phoebe — asked a room of 400 senior living executives and employees a question. She’s still shocked by the answers today. “How many of you,” Hoffman asked, “would move into your community?” Ten people raised their hands. “That was very revealing to me,” Hoffman said during a panel at LeadingAge’s annual conference this month.

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How To Empower Your Workforce With Modern Fertility Benefits

Speaker: Andrea Wuchiski

In an era where a workforce spans multiple generations, HR managers and Total Rewards leaders face the unique challenge of designing benefits packages that cater to diverse employee needs. This session will delve into how comprehensive fertility benefits can bridge generational gaps, support employees’ health, and enhance workplace satisfaction. Join us for an insightful session that highlights the strategic importance of fertility benefits in today’s competitive job market.

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World AIDS Day: Raising Awareness About the AIDS Pandemic

Healthcare Highways

Since 1988 World AIDS Day has been on the 1st of December. Notated by the red ribbon, the international day is dedicated to raising awareness about the AIDS pandemic caused by the spread of HIV infection, showing support for people living with HIV, and remembering those who have died from an AIDS related illness.

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CIO Perspective: The Crucial Role of a Trustworthy Consultant in Building a Sustainable Program

HIT Consultant

Anis Trabelsi, CIO at Palomar Health As a CIO with experience working with various consultants, I understand the importance of finding the right partner, especially in the realm of cybersecurity. Many consultants prioritize financial gains over personalized solutions, making it crucial to seek out ethical, committed and knowledgeable experts. In this article, I will highlight the key factors that make a good consultant, emphasizing the need for trust, a personal touch and a focus on tailored sol

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GoMo Health Welcomes Internationally Recognized Oral Health and Psychiatric Nursing Leader Judith Haber, PhD, APRN, FAAN to Advisory Board

GoMoHealth

FOR IMMEDIATE RELEASE: November 15, 2023 GoMo Health Shelley Schoenfeld, Chief Marketing Officer E-mail: sschoenfeld@gomohealth.com Phone: 732-484-9144 GoMo Health Welcomes Internationally Recognized Oral Health and Psychiatric Nursing Leader Judith Haber, PhD, APRN, FAAN to Advisory Board Asbury Park, NJ, November 15, 2023: New York University’s Rory Meyers College of Nursing’s Judith Haber, PhD, APRN, FAAN, Professor Emerita and Executive Director of the Oral health Nursing Education and Pract

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Lee Health System Leverages KeyCare’s Epic Platform to Provide 24/7 Virtual Care Access

HIT Consultant

What You Should Know: – KeyCare , the nation’s first Epic-based virtual care company, has partnered with Lee Health , a leading provider of healthcare in Florida, to deliver high-quality virtual urgent care with licensed providers (known as Virtualists). – Lee Health patients can now get 24×7 care across all 50 states via a virtual visit through Lee Health’s MyChart patient portal.

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Enhance Healthcare Efficiency With Top Payroll & HCM Services

Running a healthcare facility requires precision and care, not just for patients but also for your staff. Our guide, "A Buyer’s Guide to Payroll & HCM Services," helps healthcare providers choose the best provider. Efficient payroll management ensures timely, accurate payments, critical for maintaining staff morale and trust. Compliance support helps navigate complex healthcare regulations and avoid costly fines.

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Understanding the CMS 2024 Final Rule: Key Impacts of the Physician Fee Schedule on Healthcare Professionals

Advanced Data Systems

The Centers for Medicare & Medicaid Services (CMS) recently released its 2024 physician fee schedule final rule. Why are you thinking this will be ominous and not good for you? Perhaps that old joke about, “We’re from the government and we’re here to help,” is in your head.

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Meet The Circular Smart Ring Slim, The Slimmest and Lightest Smart Ring in the World

HIT Consultant

What You Should Know: Following the success of the groundbreaking Circular Ring Pro, Circular, pioneers of smart ring technology, is excited to unveil the Circular Ring Slim , the thinnest, and lightest, most intuitive smart ring in the world and the first to incorporate haptic navigation and alerts. Paired with Kira+, Circular’s powerful AI wellness assistant, the sleek Circular Ring Slim assesses 7 biometrics and 142 derived markers 24/7 to help people sleep better and live healthier liv

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Five Opportunities to Use the Law to Address Persistent OUD Treatment Gaps 

Bill Of Health

By Jon Larsen and Sterling Johnson People who need opioid use (OUD) treatment in the United States are often not receiving it — at least two million people with OUD are experiencing a treatment gap that prevents or hampers their ability to receive life-saving care and support. This reality reflects structural, policy, and legal misalignments common to the entire U.S. health care system, but that are especially present for behavioral health needs like substance use, and are exacerbated by other c

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Children’s National Hospital to Deploy Kyndryl’s AIOps & Automation Tools

HIT Consultant

What You Should Know: Kyndryl, the world’s largest IT infrastructure services provider, today announced an agreement with Children’s National Hospital (Children’s National), one of the top five ranked children’s hospitals in the nation by U.S. News & World Report, to help support the technology experience for staff by reducing friction across all technical touch points.

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Creating a Company Culture of Care: Integrating Mental Health, Wellbeing, and DEI in Benefits

Speaker: Sean Raible

Picture a workplace where physiological safety is not just an aim but a reality, driven by thoughtful employee benefits that prioritize mental health, wellbeing, and DEI. 🤔 ✨ Achieving this vision requires more than just occasional training sessions and employee assistance programs. Moving beyond the basics, this vision calls for a holistic approach that integrates these elements into your company culture as well as your HR and benefits strategy.