During the second annual EDGE Server submission, participating organizations prepare CMS submissions that are used for interim reinsurance payment calculation and interim risk adjustment summary reporting. The submission process entails cleansing and submitting data, correcting errors, analyzing a myriad of de-identified XML files and filing discrepancy reports. The 15-day extension that was given to insurers in 2015 was not provided in 2016, requiring issuers to meet the May 2 submission deadline.
The use of second-generation (i.e., atypical) antipsychotic drugs has rapidly expanded in the past decade due to superior tolerability and efficacy compared to conventional (i.e., typical) antipsychotics. From 1996 to 2004 the number of atypical antipsychotic medications prescribed in the elderly increased from 15% to 73%. This upsurge has revealed several safety alerts, the most alarming being the increased risk of mortality with specific cause of death being heart related events and infection (pneumonia in particular). In fact, the FDA issued a black box warning in 2005 indicating increased risk of death in atypical users and extended the warning to typical antipsychotic users in 2008.
There has been a lot of talk about transforming healthcare into an industry that leverages real-time analytics. Sadly, while the cost of a cup of coffee at Starbucks appears on your iPhone in seconds and your 401k reflects every change in holding and values at any given moment, healthcare has not made it easy for clinicians to leverage similar technology. In fact, patients and clinicians are often left in the dark for months after clinical events, greatly limiting the industry’s efforts to improve quality and efficiency. The infrastructure is there, and so is the technology. The only thing left is a company that will engineer the software itself.
There’s more than politics happening in Washington, D.C. October was the perfect time for hundreds of healthcare professionals to converge in our nation’s capital for the 7th annual Inovalon Client Congress to discuss the insights and trends transforming the industry. Representatives came from health plans, pharma, life sciences, government agencies, partners, academics, ACOs, health systems and research organizations. They shared industry strategies, best practices and technology innovations for improving clinical and quality outcomes, utilization efficiency, compliance and financial performance during this three-day conference.
Have you ever wondered how you can better engage your members? How do you get them to participate in preventive health measures? The easiest way to get answers to these questions is simply by asking the members themselves. In a recent Inovalon study, we went straight to the source for insight on member engagement. We learned a significant amount about motivating members to participate in preventive health programs.