Coverage Alignment: The Catalyst for Better Payer-Provider Relationships

I’ve spent over a decade in health information exchange, and while I’ve witnessed many incremental attempts to remove barriers and alleviate payer-provider friction, I’ve never seen true payer-provider partnership to reinvent and solve the core of revenue cycle management – coverage information.

Health insurance coverage is a notable example of unnecessary friction. While adoption of electronic eligibility transactions has reached 94%, payers and providers still struggle with sharing coverage data in a way that is automated, complete, accurate, and timely. A significant challenge has been a lack of interoperability, but that’s changing!

The Avaneer Coverage Alignment solution detects and matches changes in coverage information and instantly shares it with payer and providers. In doing so coverage information is accurate, up to date, and immediately accessible.

Our payer and provider participants are thrilled with the results. Providers appreciate the significant reduction in coverage-related denials and payers share how the solution helps simplify coordination of benefits.

I’m really excited to be a part of this transformational moment in healthcare. Also, I invite you to reach out to me or take a product tour to learn the value of Avaneer Health’s Coverage Alignment solution.

David Schramm
Senior Product Manager, Avaneer Health

 

In This Issue

From the Avaneer Podcast

The Spark: Lessons Learned from an Industry Disrupter

Sufian Chowdhury, founder and CEO of Kinetik, envisions a future where healthcare transportation mirrors the convenience of popular ride-sharing services like Uber and Lyft. Chowdhury sits down with Avaneer CEO Stuart Hanson and Marketing VP Rachel Schreiber to share the many insights he’s gleaned since setting out to transform the non-emergency medical transportation (NEMT) industry—an industry whose services can mean life or death for millions of individuals each year.

Listen to the podcast

Industry Highlights

Researchers Call for Outcome-Centric Approach to Health AI Regulation

Health IT Analytics

The recent White House Executive Order on the Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence seeks to prevent the irresponsible use of AI that “fraud, discrimination, bias, and disinformation; displace and disempower workers; stifle competition; and pose risks to national security,” especially in vital fields like healthcare. However, researchers believe the order omits a critical component: patient outcomes. This insightful article delves into the need for “outcomes-centric” regulations whereby companies with new AI-driven models should be required to prove clinical relevance before being allowed to bring the model to market.”

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Healthcare Administrative Spending Increased by 50%

Rev Cycle Intelligence

Healthcare organizations are getting hit from all sides by rising expenses, especially labor and pharmaceuticals. The 2023 CAQH Index Report reveals that administrative expenses are also taking an increasing toll on the bottom line, reaching nearly $83 billion, with prior authorization, claim submission, and claim status inquiry taking the top spots. This insightful article delves into the challenges and recommends strategies for thriving in this post-pandemic “new normal.”

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Doctors and hospitals praise new prior authorization rule, but some want more from Congress

Chief Healthcare Executive

The recent CMS final rule focused on overhauling the highly burdensome prior authorization process has been much anticipated and, most would argue, long overdue. However, critics of the rule say that while it’s a significant step in the right direction, it does little to advance real-time processes and reduce the number of prior authorizations overall—both of which are essential to reducing the burden of prior authorizations on providers.

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From the Avaneer Blog

What if getting accurate patient coverage could be easier?

What if providers and payers could connect to a single network and access always-refreshed, accurate, and complete primary, secondary, and tertiary patient coverage in real time—without needing a third party? Providers could spend less time chasing information and more time with patients while IT would have fewer connections to manage, reducing costs and freeing up valuable resources.

“What if” is now a reality at some of our nation’s largest payer and provider organizations.

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Looking to Connect?

Find us at these upcoming conferences or book a time to meet.

ViVE 2024 is just around the corner, and we’re looking forward to talking with payers, providers, and like-minded innovators and entrepreneurs about the exciting things happening at Avaneer Health. If you’d like to meet with our CEO, Stuart Hanson, while at the show, please reach out here.

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From 72-Hour Waits to Real-Time Rides To Save Patients’ Lives

Non-emergency medical transportation (NEMT) helps hundreds of millions of patients get to their medical appointments each year, often for critical life-saving treatments like dialysis and chemotherapy. The decades-old NEMT service industry traditionally relies on highly manual, paper-based processes that often inhibit a patient’s ability to receive the care they need and for NEMT businesses to get paid. Kinetik founder and CEO Sufian Chowdhury saw an opportunity to reinvent how this industry functions through digital innovation. Hear him talk about the obstacles he faced, the lessons learned, and what it means to be a startup in today’s complex healthcare industry.

 

 

 

 

Year in Review and Outlook for 2024

Insider News for January 2024

Happy New Year! I hope 2024 is off to a great start for you and your organization. It certainly is at Avaneer Health. Our team had a ground-breaking 2023 as we set, met, and exceeded some aggressive goals and milestones. We ended the year confident in our product-market fit, growth strategy, and priorities for 2024.

I am very proud of our team’s achievements in 2023 and I want to share just a few ways we worked together to #makeitreal.

We will continue building on our successes in 2024 and beyond. While interest in our network and platform continues to gain momentum, our Coverage Alignment solution has been especially compelling for many prominent regional and national healthcare organizations who see the potential to lower costs and transform administrative processes.

We’re also developing new solutions that meet the needs of both payers and providers. This is a distinctive approach to driving improvements in healthcare and we’re looking forward to announcing the details throughout the coming year.

Here’s to a great 2024!

Stuart Hanson
Chief Executive Officer, Avaneer Health

PS – Don’t miss our podcast conversation with an innovator in the health improvement space, Jeff Ruby, CEO of Newtopia. It’s a hot topic for January!

In This Issue

Industry Highlights

Setting the revenue cycle up for success in automation and AI
McKinsey & Company

For years, we’ve heard about the promising value of automation technology and analytics in reducing administrative complexities. Yet, that value has been slow in coming. This insightful and timely article delves into the challenges and posits that the value is finally at hand but says “capitalizing on the next wave of technologic innovation entails investing in the right mindsets, infrastructure, and capabilities throughout the revenue cycle and beyond.”

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Why a Former ONC Chief Thinks TEFCA Is Inherently Flawed
MedCity News

The Trusted Exchange Framework and Common Agreement (TEFCA) is now operational. Several leaders in the industry are saying that it might not live up to its promises of improving interoperability and data access. In this thought-provoking article, Donald Rucker, MD, former National Coordinator for Health Information Technology (ONC), explains why he thinks TEFCA may actually “set interoperability back.”

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From the Avaneer Podcast

The Spark: Innovating Health Improvement

We recently sat down with Jeff Ruby, founder and CEO of Newtopia, an innovative, personalized, whole health platform helping people create positive lifelong habits that prevent, slow, or reverse chronic disease while reducing healthcare costs. The discussion centered around our shared passion and commitment to leveraging technology and analytics in a new way that challenges the healthcare “status quo” and ultimately changes healthcare experiences for all.

Listen here

From the Avaneer Blog

3 ways IT leaders can improve the business transactions of healthcare

Interoperable data platforms, automation, and AI have the potential to transform our industry by enhancing patient experiences, improving outcomes, lowering costs, and significantly reducing clinical and administrative inefficiencies.

Read how

Reinventing the Back Office to Deliver on the Patient-Centric Promise

We all have experienced, or know someone who has experienced, a time when our ability to receive care was inhibited due to inefficient administrative processes. Sadly, delays in care are far too common simply because payers and providers can’t easily share patient coverage or other vital healthcare data. Avaneer Health sees a new way forward, where data is always available, always updated, and always complete. Patients get the care they need when they need it, and providers and payers eliminate the costly, time-consuming back-and-forth to chase down information. We’re reinventing the back office to deliver on the long-overdue patient-centric promise.

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Transforming Healthcare through Habit Change

In this episode, Jeffrey Ruby, founder and CEO of Newtopia, explains the focus and mission of his habit change company, which aims to prevent, reverse, and slow chronic diseases while reducing healthcare costs. Throughout the conversation, he talks about Newtopia’s approach,  including its partnerships with employers, health systems, and value-based providers. Jeff discusses the company’s emphasis on primary prevention, the whole health approach, and the use of personality and behavioral genetics to match participants with coaches. He also highlights Newtopia’s success in engaging individuals, achieving positive health results, and their collaboration with Alice Walton’s Heartland Whole Health Institute.

Tune into this episode for insights into Newtopia’s innovative approach to healthcare and its efforts to shift the focus towards keeping people healthy rather than solely managing illnesses!

Healthcare happens in real time. Shouldn’t your data?

Insider News for Nov/Dec 2023

Our team has fun calling out the obvious challenges of creating and launching healthcare infrastructure. Among our many sarcastic hashtags, we use #killthefax. It reminds us that it wasn’t that long ago that medical records were paper, data comes in multiple formats and is often in disparate databases, and our industry is still in the midst of digital transformation. It’s a paradox that most healthcare technology professionals will understand.

Further, AI is on everyone’s mind as a transformative technology across many industries. At the same time, data sharing in healthcare is still done via fax. This century-old technology still has us firmly in its grip, even as AI-enabled healthcare solutions are hitting the market!

No more excuses

The fact is that we can communicate without the fax machine. We can share data and transact with others in real time. And we can apply AI to large data sources to glean critical insight. Through the increasing adoption of industry standards like FHIR, we’re able to normalize data and continue to make progress and evolve. The challenge is that developing and deploying FHIR-based solutions is expensive and requires extensive IT resources to manage.

There’s a better way

The Avaneer Health network and platform are designed for interoperability and simplicity. With a modern, secure infrastructure and a built-in suite of FHIR-enabled tools, payers and providers can communicate and transact directly without requiring huge infrastructure investments. And because the network enables permissioned and audited data sharing without data aggregation by Avaneer Health, it eliminates the need for third-party solutions, giving data owners more control over their data.

There’s no excuse to stay tethered to the fax, file exchanges, or data aggregation. Payers and providers can begin reaping the rewards of greater interoperability today.

Gerald Bortis, PhD

Chief Technology Officer, Avaneer Health

In This Issue

Industry Highlights

Identifying the right use cases for federated learning and analytics

Integrate.ai

Most data science initiatives fail because they don’t have access to the appropriate data. But that’s changing thanks to federated learning for data silos. “In traditional machine learning, all data must be centralized in one database before training a model. In federated learning, models are trained on decentralized datasets – that is, the data resides in two or more separate databases and never needs to be moved.”

This insightful article shares the five steps to identifying use cases for federated learning.

Read More

Featured Avaneer Content

What if you could access all active and inactive coverage data in real time without aggregating data? And what if that information were always updated and available within your own system? It’d lead to:

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Collaboration Services for Developers: tools and services for launching solutions

Watch a short demonstration of how Avaneer Collaboration Servicesᵀᴹ enables developers to launch solutions seamlessly and automate workflows.

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From the Avaneer Podcast

New podcast focusing on innovation

The Avaneer Health team is launching a new podcast that will feature discussion with innovators who are disrupting how healthcare works, truly transforming processes and infrastructure, and challenging the status quo. Our first episode describes our vision for the podcast.

Listen here

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