By Rahul Ajmera, SVP of Provider Market, CitiusTech.
Over three years since U.S. healthcare providers and payers adopted new cost transparency regulations designed to make healthcare costs more accessible. While the intent behind these regulations is in empowering consumers to compare prices across various healthcare services and insurance options, many healthcare organizations continue to struggle or are hesitant in achieving full compliance.
This article aims to quickly decode & rethink the importance of price transparency rules for healthcare organizations, with a change in mindset–embracing it not only as a regulatory requirement but also as a pivotal chance for enhancing care services, improving patient experience, and gaining a competitive edge.
Understanding the compliance gap
The journey to compliance has been slow for some either since pandemic-related disruptions or owing to resource limitations. Many organizations still find it difficult to navigate the intricacies of these regulations, which require a comprehensive overhaul of existing data management practices. The process involves consolidating diverse data sets from various systems and ensuring they are structured appropriately for public disclosure–additionally, a demanding skill set from IT, if they are already overstretched. But before we dive into the complexities, it is due to note that if compliance becomes more widespread, organizations may discover new avenues for more than just operational improvements through careful analysis of the data generated, lead to better patient experience and give competitive edge.
Opportunities for improvement
The push for price transparency presents not just challenges but also opportunities. By making pricing data readily available, hospitals and insurers can facilitate better consumer understanding of direct expenses made. Moreover, the new pricing landscape allows organizations to leverage data analytics at a vantage point. By utilizing data-driven insights gleaned from commercial rates that payors are mandated to publish, healthcare providers can identify reimbursement rates in their participation agreements that are too low relative to what other providers are receiving.
Access to the new price transparency data opens opportunities to modernize and expand traditional health data models to incorporate and analyze vast amounts of unstructured pricing data, offering real-time insights and personalized recommendations to consumers. Advanced analytics and Generative AI can be leveraged to optimize supporting documents for claims, and to simplify complex medical billing correspondences, making it easier for patients to understand costs. An established technology known as Knowledge Graphs can be incorporated with Generative AI to link related data points, ensuring that pricing information is not only accurate but also contextually relevant, driving better decision-making for both providers and patients.
By Caroline Hodge, CEO and co-founder, Dimer Health.
The healthcare industry is at a pivotal juncture, with $320 million in Medicare readmission penalties impacting 2,273 hospitals this year alone. These penalties go beyond financial strain, influencing patient well-being and the sustainability of hospital operations. Amid these challenges, AI-driven innovation offers transformative solutions that could change how hospitals manage post-discharge care. The pressing question is: how can healthcare systems better support patients after discharge to reduce readmissions and enhance overall care?
AI-driven solutions are revolutionizing post-discharge care with a proactive, predictive approach that surpasses traditional reactive methods. By leveraging AI-powered predictive analytics and continuous patient monitoring, potential health issues can be identified early, enabling timely intervention to prevent complications from escalating into readmissions. This accurately predictive component is pivotal, as it not only enhances patient outcomes but also eases financial burdens on hospitals, shifting the model from penalty-focused to performance-driven incentives.
Dimer Health is at the forefront of this movement. By combining real-time AI analytics with a dedicated clinical team, Dimer informs a predictive and proactive care delivery system that bridges the critical gap between hospital discharge and full recovery. This comprehensive approach has already demonstrated significant reductions in readmission rates, showcasing a new benchmark for effective, continuous patient care.
As the adoption of AI in healthcare grows, questions about its impact on future policy and reimbursement frameworks come to the fore. Could integrating AI into post-discharge care pave the way for a shift from penalty-heavy models to value-based, patient-centric incentives? Policymakers and healthcare leaders will soon need to assess how these technologies can promote sustainable care models that benefit patients and the healthcare ecosystem.
The implications are substantial. In an era marked by an aging population, escalating healthcare costs, and workforce shortages, AI-enabled care can become a cornerstone of hospital strategy. As healthcare systems start to leverage these capabilities, there is potential for more resilient, patient-focused care models that align with both economic and clinical objectives.
This evolution is about more than technology; it represents a shift toward reimagining patient care, making continuous, personalized support the new standard in healthcare. The question now is how swiftly and effectively the industry can adapt to this promising frontier.
Marchex (NASDAQ: MCHX), which harnesses the power of AI and conversational intelligence to drive operational excellence and revenue acceleration, today announced the phased rollout of its vertical-specific advanced AI solutions for lead identification, lead value assessment, and trending topics discovery.
These innovative AI solutions deliver descriptive, predictive, and prescriptive insights that enable businesses to improve return on ad spend, understand the primary elements driving changes in customer behavior, and increase sales. Launching in Q4 2024, these solutions are tailored for automotive OEMs and dealers, home services, medical, dental, and automotive services.
“As businesses strive to make informed decisions and drive impactful business outcomes, these new AI solutions underscore our commitment to transforming customer data into a strategic advantage.”
Advanced AI Solutions key benefits:
High-Value Lead Identification: Scoring that reveals the highest potential leads.
Industry-Specific Customization: Businesses receive the most relevant, actionable insights.
Data-Driven Decisions: Track trends, optimize resource allocation, and make informed decisions based on comprehensive customer insights.
Marketing Optimization: Industry specific lead and appointment rate models that optimize marketing campaigns to drive high-value leads.
Improved Attribution: Segment target audiences and improve automated bidding using any combination of lead outcome, lead value, and topics.
Understand relevant customer topics: Identify topics and trends that are most important to a successful sale and customer experience.
“Marchex’s industry leading AI solutions provide an unprecedented level of visibility into customer interactions, offering industry-specific context so businesses can better understand lead value and lead outcomes, the topics that matter most to their customers, and how those topics change over time,” said Troy Hartless, Chief Revenue Officer at Marchex. “As businesses strive to make informed decisions and drive impactful business outcomes, these new AI solutions underscore our commitment to transforming customer data into a strategic advantage.”
By Stephanie Jamison (Greenway Health), Chair, EHR Association Executive Committee
It’s been 20 years since 21 of the industry’s leading EHR vendors came together to create the HIMSS EHR Vendor Association in 2004 to accelerate the widespread adoption of EHRs. The new association was also tasked with helping HIMSS establish its strategic direction and official positions on issues related to the EHR and providing input and feedback on the certification process established by CCHIT.
Now called the EHR Association, what started as a bold concept is still going strong in 2024 with a current membership base of 29 companies: competitors working collaboratively to advance health data interoperability, safely embrace new technologies, and improve the quality and efficiency of care. Our initial focus on furthering the initiatives laid out in the Health IT Strategic Framework, released in July 2004 by the Office of the National Coordinator for Health Information Technology (now known as the Assistant Secretary for Technology Policy, or ASTP), has expanded and evolved along with the state and federal regulatory environment.
At the time, founding Chair Charlene Underwood described the establishment of the EHR Association as a historic opportunity to directly impact healthcare delivery in the US, noting in the press release announcing the new association that “EHR technology has proven its ability to make healthcare safer, more efficient, and more convenient for patients as well as providers.
“As EHR vendors,” she continued, “we have a responsibility to our customers to shape the future of interoperability for effective and secure sharing of patient data, and to the nation to promote the widespread adoption of this life-saving technology.”
Today’s health IT market is vastly different from those early years when hospital EHR adoption was 9% and office-based physician practice adoption was 17%. Now, well over 96% of hospitals and 78% of physicians use an EHR, most of which are certified through the ASTP-driven process. In the years since its establishment, many of the EHR Association’s founding member companies have gone through acquisitions or mergers, and new entrants have stepped up.
The Developer’s Voice
The Association’s record of accomplishments since 2004 reflects the health IT market’s evolution. Over the years, we’ve worked to ensure our members’ voices were heard on regulatory and policy issues of critical importance to both EHR developers and the providers using our technologies. We’ve met with policymakers and submitted comments on everything from meaningful use and standards development to the Nationwide Health Information Exchange and TEFCA to the 21st Century Cures Act and, most recently, HTI-1 and HTI-2.
Our efforts weren’t limited to offering recommendations and feedback, however. We’ve held numerous Congressional Briefings over the years, focusing on issues such as the role of EHRs in value-based care and the 21st Century Cures Act, as well as COVID-19 and health IT, information blocking, and social determinants of health and health equity.
We’ve also leveraged our collective expertise to provide member companies with tools to navigate a tumultuous regulatory landscape. This includes publishing the industry’s first EHR Developer Code of Conduct reflecting our members’ commitment to supporting safe healthcare delivery, fostering continued innovation, and operating with high integrity in the market—a commitment we maintain to this day.
Harris Data Integrity Solutions, the leading provider of best-in-class patient data integrity services and software, announced today the promotion of Rachel Podczervinski, MS, RHIA, to Senior Vice President. In her new role, Podczervinski oversees Harris Data Integrity Solutions’ mission to ensure accurate patient identity management through innovative services and software solutions.
Podczervinski brings nearly 25 years of healthcare experience to her new role. Previously, she was vice president of professional services for Harris Data Integrity Solutions, which was created by the integration of Just Associates, Inc. and QuadraMed Corp. Podczervinski originally joined Just Associates in 2005 as a patient identity expert, rising through the ranks with positions including quality assurance specialist, identity manager, and director.
“An unwavering focus on quality and innovation has made Harris Data Integrity Solutions the leading partner for hospitals and health systems that recognize the vital importance of protecting the integrity of their patient data,” says Podczervinski. “I am honored to be entrusted with guiding the future direction of this organization and am excited for what the future holds for our team and the healthcare organizations we support.”
A recognized thought leader in the field of health informatics, Podczervinski brings a wealth of knowledge and expertise to Harris Data Integrity Solutions and the healthcare industry. She speaks frequently at leading industry conferences, providing insights on patient identity and EMPI management, has authored numerous articles for leading industry journals and publications, and was named a Rising Star by the Colorado Health Information Management Association (CHIMA). Podczervinski, who holds a master’s degree in health information management and medinformatics, is active with AHIMA and is an avid volunteer and mentor.
MDaudit, an award-winning cloud-based continuous risk monitoring platform for RCM that enables the nation’s premier healthcare organizations to minimize billing risks and maximize revenues, announced today that its MDaudit billing compliance and revenue integrity platform is a finalist in the 2024 Fierce Healthcare Innovation Awards.
MDaudit is a finalist in the Data Analytics/Business Intelligence category, which recognizes innovative data analytics tools that bring actionable information directly to users by either enabling the wide dissemination of clinical, financial or operational data, or helping them make sense of it. Currently, more than 1 million cases and $8 billion in charges are audited annually on the MDaudit platform and more than $150 billion in denials are analyzed for potential reimbursement. Additionally, more than 5 billion claims are used for benchmarking via MDaudit.
Ritesh Ramesh
“The innovation strategy at MDaudit starts with our customers; they are at the center of everything we do,” said Ritesh Ramesh, CEO, MDaudit. “This recognition from Fierce Healthcare is a huge acknowledgment of our effort to deliver tangible business outcomes to our customers in the U.S. healthcare system. A huge shout out to our team and partners who work with us diligently every day to innovate and make a difference.”
From Questex’s Fierce Healthcare, Fierce Biotech and Fierce Pharma, the Fierce Healthcare Innovation Awards identify and showcase outstanding innovation that is driving improvements and transforming the industry. Two expert panels of judges determined which innovative solutions demonstrated the greatest potential to save money, engage patients, or revolutionize the industry based on effectiveness, technical innovation, competitive advantage, financial impact, and true innovation. Winners will be announced in the Innovation Report on December 2, 2024.
In a LinkedIn post announcing the 2024 finalists, Fierce Life Sciences Events wrote, “These forward-thinking organizations have demonstrated excellence in healthcare technology, patient care, operational advancements, and more, setting new standards across the industry. Their innovations are transforming healthcare delivery and improving patient outcomes.”
AGS Health, a leading provider of tech-enabled revenue cycle management (RCM) solutions and a strategic growth partner to healthcare providers across the U.S., has received a UiPath AI25 Award for the company’s innovative use of automation and AI to support greater accuracy and efficiency in the intake and management of faxed documents.
Despite efforts to eliminate faxing, use of this cumbersome, inefficient, and costly technology by healthcare organizations remains prolific. Over 9 billion fax pages are exchanged annually at a cost of $125 billion, significantly straining already limited resources.
AGS Health’s IntelligentFax Processor automates this process, accelerating indexing, enhancing accuracy, reducing costs, and improving efficiency by leveraging a hybrid workflow model combining GenAI and robotic process automation (RPA) with manual indexers to handle exceptions. The system can handle a wide array of document formats and types, including consultation notes, test results, and medical records. Powered by advanced AI, it learns and adapts to the unique fax templates of each organization, ensuring accurate data extraction and categorization.
The annual UiPath AI25 Awards recognize the 25 most innovative UiPath customers using a combination of AI and automation as a strategic change enabler to accelerate bigger and bolder outcomes. AI and automation are redefining what’s possible—not just in business, but in the ways we work and live. This powerful combination creates fast, comprehensive, and actionable insights to inform decisions—uncovering never-before-seen opportunities for productivity and innovation.
I’m a confirmed AI optimist and believe the technology will improve healthcare on a broad scale, from diagnosis to drug discovery, precision medicine, robotic surgery, record keeping, analytics, population health, and streamlined claims processing.
But there remains one nut that AI, for all its astonishing promise, hasn’t yet cracked – the growing burden of healthcare costs on the American family. No large language models or artificial neural networks are likely to change that in the near future.
Rather, the nearest-term solution to rising premiums, deductibles, co-pays and out-of-pocket costs is embarrassingly analog. It’s a conceptual change in the payment process. We need to change the business model until technology can do more to lower our collective costs.
The cost of care avoidance
The current model is broken. Most Americans are covered by an employer’s health insurance plan, but it’s not a gift. The employer and employee share the premium.
Unfortunately, family coverage premiums have increased by 22% in the last five years, reaching almost $24,000. When a covered employee seeks treatment, they pay out of pocket up to their deductible and often owe a co-pay. Since 1960, out-of-pocket costs have grown nearly twice as fast as the economy.
If the patient can’t pay at the time of service, which is increasingly common, the household carries a balance and pays interest on that balance indefinitely, absorbing considerable financial stress along the way. Providers become de facto bill collectors, something they did not sign up for when pursuing careers in healthcare. Shamed patients avoid the doctor, risking their health and nudging up longer-term healthcare costs for everyone. More than four in 10 adults (43%) say they or a household member have put off or postponed care due to cost.
Marchex
By Stephanie Jamison (Greenway Health), Chair, EHR Association Executive Committee
By Bob Chin, chief information officer,