Meaningful Analytics – Using Business Intelligence to Decrease Healthcare Costs

On the surface, the recent statement from the Center for Medicare and Medicaid Services (CMS) concerning the prevention of $210 million in fraud over the last two years (1) appears to be a good thing. Yet, aside from giving the government a pat on the back for its auditing skills, the news is overshadowed by the National Institute of Health Care Management Foundation’s (NIHCMF) recent...

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How Delta Dental of Missouri used the power of the cloud to engage and grow their direct to consumer sales

Addressing the rapidly growing individual health insurance market is one of the single biggest challenges—and opportunities—health plans face today. Reforms such as the Affordable Care Act in the US has catalyzed an unprecedented spike in demand for consumer health insurance products. How can your health plan adapt quickly to not only meet this new demand, but differentiate itself from the...

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HIPAA audits are coming

Healthcare organizations who may have been hibernating this winter received a gentle wakeup call quickly followed by a not-so-gentle one this past Monday.  After a quick re-tooling following a pilot program, it appears that the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) is preparing to kick off its official HIPAA compliance audit program very soon. …

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CAQH my COB ASAP

This week saw significant healthcare news out of Washington D.C. as the CAQH (Council for Affordable Quality Healthcare) and several major health plans released a new coordination of benefits (COB) registry called COB Smart, aimed at enabling providers and health plans to identify individuals with multiple forms of coverage before care is delivered.…

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Hits Keep on Coming: High Availability & Disaster Recovery at Healthcare.gov

When it comes to the IT challenges of the new Healthcare.gov Healthcare Exchange, the hits keep on coming.  Over the weekend, the healthcare.gov hosting vendor, Terremark (a subsidiary of Verizon), “experienced a failure in a networking component” and the attempted fix crashed the system.  The failure is in the “Data Services Hub,” which connects the exchange to other...

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Healthcare.gov: A Flawed Rollout but a Familiar Story

Tuesday morning on my way to the office, I saw this headline at the top of the front page of the Wall Street Journal: “Obama Admits Health Website Flaws“. If you read the article or scan related news about Healthcare.gov, you’ll notice a variety of reported issues. One sentence stood out as a personal reminder of some painful experiences: “the decision to require all...

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From Cars to Hospitals: Lean Processes in Healthcare

During one of my first consulting engagements, my client had a penchant for veering off topic.  So naturally when she brought up her black belt in Lean Six Sigma, I assumed she was about to share her interests in martial arts.   During my time in the hospital as a medical student and surgical resident, I had never heard of Lean processes, let alone Lean Six Sigma. …

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Bitter Pill Indeed – Answering with a Call to Action

This month Time Magazine published their longest article in the magazine’s history – ~27,000 characters.  I downloaded it from their site and printed it out (double sided of course) and it was 30 pages:  “Bitter Pill:  Why Medical Bills Are Killing Us” written by Steven Brill.  I haven’t read an article on the landscape of healthcare that has been this thought...

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Merge, Acquire, then Repeat

With all of the statements that have been made about healthcare this year, one of the most compelling we’ve heard came from Aetna’s CEO, Mark Bertolini, during the HIMSS12 conference when he decisively proclaimed, “the end of insurance companies, the way we’ve run the business in the past, is here.” The activity we have seen recently in the area of Mergers and...

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Chicago, IL 60606
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