Healthcare Payers

How Elevance Health, MVP Health Care Are Leveraging Data Analytics

July 5, 2023 - Payers rely on accurate, high-quality data to make health insurance processes more efficient and support improved patient outcomes. However, each beneficiary generates a plethora of data points throughout their care journeys that payers must sift through. Many payers have turned to data analytics solutions to transform healthcare big data into actionable insights, including Elevance...

Read More


More Articles

AMA Seeks More Oversight of Prior Authorization Artificial Intelligence

by Shania Kennedy

During its recent Annual Meeting, the American Medical Association (AMA) House of Delegates adopted a policy calling for increased regulatory oversight of health insurers’ use of artificial...

FL Health System Leverages AI to Streamline Utilization Management

by Shania Kennedy

Florida-based Halifax Health deployed an artificial intelligence-based solution to streamline utilization management workflows across its three hospitals this week. The health system will leverage a...

Partnership Aims to Improve Health System Utilization Management with AI

by Shania Kennedy

AnMed, a nonprofit health system serving residents of upstate South Carolina and Georgia, will leverage XSOLIS’ artificial intelligence (AI) and machine learning (ML) tools to drive greater...

Using AI to Streamline the Provider-Payer Relationship

by Shania Kennedy

Providers and payers play key roles in healthcare delivery. More often than not, the two must collaborate to ensure that patients and beneficiaries move through their care journeys as efficiently as possible while complying with state and...

Florida Blue to Use New AI Tool for Prior Authorizations

by Erin McNemar, MPA

GuideWell’s subsidiary, Florida Blue, will become the first US payer to automate prior authorization approvals through a new artificial intelligence-powered clinical reviews tool developed by...

Gateway Health Taps Population Health for Maternal Health Outcomes

by Emily Sokol, MPH

Gateway Health Plan has partnered with the 1889 Jefferson Center for Population Health to improve the outcomes of expecting mothers and babies. The managed care organization will work with 1889...

Precision Medicine Informs Cost-Effective Heart Disease Treatments

by Jessica Kent

Using precision medicine approaches to tailor heart disease therapies could lead to more cost-effective treatments and improved patient outcomes, according to a study led by researchers at the...

Artificial Intelligence Saved Over $260M in Fraud, Waste in 2019

by Jessica Kent

Highmark Inc.’s Financial Investigations and Provider Review (FIPR) department has leveraged artificial intelligence to generate over $260 million in savings associated with fraud, waste, and...

CVS Health Announces Precision Medicine Program for Oncology

by Jessica Kent

CVS Health has launched Transform Oncology Care, a precision medicine program that uses genomics at the point-of-prescribing to help patients start on the best treatment faster. The program will also...

CA Representative Reintroduces Precision Medicine Access Bill

by Jessica Kent

California representative Eric Swalwell recently reintroduced the bipartisan Advancing Access to Precision Medicine Act, which aims to increase the use of genomic and genetic testing for pediatric...

BCBS Announces Finalists of Claims Data Analytics Challenge

by Jessica Kent

Blue Cross Blue Shield (BCBS) and Blue Health Intelligence (BHI) have named five finalists in their claims data analytics challenge. The selected companies will use a subset of BHI’s national...

Best Practices to Develop a Social Determinants of Health Strategy

by Emily Sokol, MPH

Addressing the social determinants of health (SDOH) in a community can seem like an insurmountable task, but Humana’s best practices show that a changing health system is ready to tackle these problems. The SDOH are factors outside...

Blue Cross Blue Shield Launches Claims Data Analytics Challenge

by Jennifer Bresnick

Blue Cross Blue Shield Association (BCBSA) and Blue Health Intelligence (BHI) have launched a claims data analytics challenge open to innovators across the industry. The payer organization is looking...

Humana Makes Progress on Social Determinants of Population Health

by Jennifer Bresnick

Humana’s Bold Goal project is continuing to bear fruit for individuals with chronic conditions as the payer focuses in on addressing the social determinants of population health. The ongoing...

Data Scientists in High Demand for Healthcare Providers, Payers

by Jennifer Bresnick

Healthcare providers and payers are competing furiously with health IT vendors to secure experienced data scientists and machine learning experts in a highly competitive job market, says a study...

AMA, UnitedHealth Partner for Social Determinants ICD-10 Project

by Jennifer Bresnick

The American Medical Association and UnitedHealthcare have announced a new collaboration aimed at generating new ICD-10 codes to identify and address the social determinants of health. The two...

Anthem Blue Cross, Stanford to Use AI for Price Transparency

by Jennifer Bresnick

Anthem Blue Cross will become the first founding member of a new Stanford University-based collaboration to accelerate the adoption of artificial intelligence in healthcare. The AI for Health...

Healthcare Payers Are Keen on Analytics, But Feel Unprepared

by Jennifer Bresnick

Big data analytics is a top priority for the majority of healthcare payers in 2019, but relatively few feel adequately prepared to succeed with becoming data-driven organizations, according to a new...

Blockchain Offers Promising Path to Better Provider Directory Data

by Jennifer Bresnick

As the volume of big data continues to increase exponentially and the pressure to reduce wasteful spending intensifies, healthcare organizations are broadening their search for secure and seamless data...

Recent Articles

Upcoming Webcasts