AI has the potential to significantly improve prior authorization, payment structures, and patient navigation.  In this episode, Brian Urban, Director of Innovations and Emerging Markets at FinThrive, talks about why understanding and utilizing non-clinical data is crucial for addressing social health needs effectively. He explains how FinThrive, a leading revenue cycle management company, is addressing issues like payment integrity, care coordination, and social health needs. Brian emphasizes the importance of AI in reducing remittances and friction and improving provider-payer relations ..read more

Navigating healthcare economics, particularly Medicare Advantage, presents challenges but offers learning opportunities. In this episode, Ed Liebowitz, EVP and Chief Strategy Officer at Solera Health, discusses his path from being diagnosed with juvenile diabetes at 26 to getting inspired for a bright career in health tech. Solera Health started by supporting digital diabetes prevention and expanded to cover various health areas, including mental health, weight management, and hypertension.  Ed explains how the company utilizes a pay-for-performance model, ensuring cost-effective, clinica ..read more

True power lies in naivety, creativity, curiosity, and courage, transforming visionary ideas into tangible outcomes. In this episode, Christian Coachman shares insights from his journey from academia to entrepreneurship, emphasizing the essential qualities of naivety, creativity, curiosity, and courage that have fueled his success. He explores the development of Digital Smile Design, the importance of collaboration to enhance patient outcomes, and his philosophy of sharing ideas to foster innovation while addressing challenges in the dental industry, such as clinicians' business acumen and mai ..read more

AI and predictive analytics offer exciting possibilities for improving patient care and operational processes. In this episode, Jonathan Adam Fialkow emphasizes the importance of empathy and support in medical care, personalized and value-based care strategies, and the effective use of technology in cardiology and population health. He highlights the necessity of addressing provider burnout, the benefits of team-based and concierge care, and the rapid development of big data technologies while also covering how digital tools improve patient engagement and streamline care management, leading to ..read more

A holistic approach to healthcare involves engaging members in preventive care rather than waiting for them to become sick. In this episode of the AHIP 2024 series, Nicholas Kraft, Chief Growth Officer at CDPHP, discusses the health plan's dedication to innovation and quality in healthcare. CDPHP, a physician-led nonprofit serving 400,000 members in New York's Capital District, prioritizes community care, challenges high healthcare costs, and promotes collaboration among leaders to improve healthcare access and affordability. Nicholas highlights the potential of fee-for-service 2.0, emphasizin ..read more

The Clinic by Cleveland Clinic and Amwell’s collaboration bridges geographical gaps in specialist care. In this episode of the AHIP 2024 series, Frank McGillin, CEO of The Clinic by Cleveland Clinic, explores how their joint venture with Amwell is transforming healthcare by providing virtual access to over 3,500 specialists. This innovative platform, available through various channels like direct visits, health plans, and employers, helps users better understand their diagnosis and treatment, significantly reducing the risk of misdiagnosis and saving about $8,700 per second opinion. Throughout ..read more

Real-time access to patient data through electronic medical records' APIs is a game-changer for healthcare analytics. In this episode of the AHIP 2024 series, Donald Rucker, the Chief Strategy Officer at 1upHealth, discusses the critical role of modern data representations and FHIR APIs for payers and providers. He highlights the significance of electronic medical records and their APIs for real-time patient data access and analytics, explaining how payers can utilize the Bulk FHIR API for core data and how advancements in JSON and RESTful APIs have made clinical data access smarter and more e ..read more

The demand for mental health and substance use services is growing, requiring more clinicians and alternative support roles like coaches and peers. In this episode of the AHIP 2024 series, Solome Tibebu, founder and CEO of Behavioral Health Tech, discusses the importance of payer partnerships with digital health innovators in behavioral health. She emphasizes the need for collaboration to ensure members are directed to the right services, particularly for specialized conditions like eating disorders and OCD, while also highlighting the role of technology, health equity, and innovation in expan ..read more

No chronic inflammation in the body is the foundation of longevity. In this episode, Dr. Miguel Stanley discusses the critical connection between dentistry and overall health, stressing the need for better communication between doctors and dentists, integrating medical and dental records, and understanding the systemic impact of oral health. Highlighting his innovative approach to interdisciplinary dental practices and Missing Link AI's ability to identify hidden dental diseases through X-ray scans, he shares his mission to revolutionize dentistry with a focus on patient well-being and advance ..read more

Synchronizing provider data between health organizations and insurance companies ensures accurate information and reduces costs. In this episode of the AHIP 2024 series, Eric Demers, CEO of Madaket Health, discusses his company’s role in benefitting patients through reducing administrative waste and enhancing efficiencies for providers and payers. By streamlining and automating functions, Madaket Health helps synchronize provider data between health organizations and insurance companies, ensuring accurate information flow and reducing costs. Eric stresses the importance of accurate provider da ..read more