Welcome to the latest #DataRX Report, a weekly digest of interesting news and trending topics in the healthcare industry. Every Friday we're pulling together the best articles and insights to keep payors and providers informed, engaged and up to date on the headlines that are impacting the industry.
Medical Cost Trend
Heading into 2019, medical cost trends remain stable yet unsustainably high as healthcare costs continue to rise. PWC breaks down the factors affecting the 2019 medical cost trend which include medical technology and innovation, government regulation, payment models, demographics and general inflation. See how this will affect payors and providers in the coming year.
Prescription for Payors
Every state needs a database with all health insurance claims, not just some
California spends $367 billion a year on health care, which is too much. To solve the problem, the state is trying to develop an all-payer claims database. The purpose of this database is to aggregate public and private payer sources and build transparency. Find out how it could work here.
Quality Analytics, Risk Adjustment Tools Prep Payers for Success
KLAS found that quality reporting technologies continue to provide significant value to health plans of all sizes, but more so for smaller health plans that need to maximize the use of quality data. KLAS interviewed 84 health plans to determine which technology vendors were able to use to best support predictive analytics, risk adjustment and care quality intervention strategies. See which tools made the cut.
Insurers Fall Short In Catching And Reporting Medicaid Fraud, Inspectors Find
Despite receiving billions of dollars in taxpayer money, Medicaid insurers are lax in searching out fraud and neglect among medical providers. Health insurers found $57.8 million in overpayments related to fraud or abuse in 2015. Check out the whole story here.
Prescription for Providers
The Most Common Healthcare Challenges & Our Solutions
With unsustainable medical costs and healthcare data doubling every eighteen months, how prepared are you to face the ever-changing, healthcare data ecosystem?
Top data analytics challenges facing healthcare organizations
When health executives were asked to grade their organization on use of Big Data to reduce costs and improve quality, 40% responded with a “B,” while 36% responded with a “C.” Learn more about other pain points they identified here.