Choosing your health plan: HMO? PPO? Why not DPO?

PAULA MUTO | November 2, 2021 | 6 views

The fall is a time of renewals and choices.  It is also a time of so called “open enrolment” for health plans. It is the one time of year we can study and learn about the options offered through employers or government sponsored plans.  Individuals and small business owners alike are also are faced with a myriad of choices with confusing and often contradictory language promising lower premiums with higher out of pocket costs for covered services subject to deductibles. What does it even mean anymore when your monthly premiums exceed your pay check and you still have to pay for your colonoscopy or your insulin? Where is it all going?

Let’s imagine you twist your ankle playing basketball.  You might go to an urgent care, receive an X-ray, probably be examined by a non-physician, and then referred to your primary care, who can’t see you for a few weeks but eventually sends you to an orthopaedic who takes another X-ray and treats your injury. Weeks have passed, multiple visits, time out of work, and co-pays, not to mention the out-of-pocket fees associated with imaging and perhaps a $100 ace bandage.  What stops you from going straight to the ankle specialist in the first place?  First, we have become conditioned to follow the directions dictated by the insurance companies, even when restrictions are not in place, patients have been convinced that stepping out of line will make all insurance promises null and void resulting in catastrophic bills and financial ruin.  Second, the doctors and their office staffs have been conditioned to deny entry to any patient who does not have the proper referral, authorization, or identification. There are dire consequences for both if the insurance rules are not followed and fear keeps both sides aligned.

The past two decades have seen an explosion of healthcare costs. Health insurance has become the single biggest line item second only to payroll for most businesses.  It is no coincidence that as the government increased its role as payor with state subsidies, the prices have gone up.  Much like college tuitions, when loans are easy to obtain and guaranteed by federal support, there is little to deter those in charge from increasing the price.  After all, everyone is doing it, it must be OK, and even if students end up in debt, it will be repaid because they have received the value of a great education. Right?  But unlike higher education, healthcare is a necessity. We cannot avoid it, and there needs to be a reliable mechanism in place to guarantee access.
Ironically, as charges and prices have continued to escalate, payments to doctors have diminished. Why medicine is the only service industry where there is no transparency is truly astounding, especially since the there has been no increase in so called “reimbursements” for decades. As physicians, we have been complicit, being fully aware of the discrepancies between what is charged and what a patient’s insurance will pay.  Even as patients began to have higher deductibles, and therefore higher out of pocket expenses, we continued to follow the rules, asking insurance permission to collect payment from the patient.  It is not surprising that bad debt accounts for over 50% of most account receivables and why over 70% of doctors are now employed by hospital networks or private equity, who not only go after patients, but benefit from the repricing that occurs when insurers pay a negotiated amount as opposed to the charge. In other words, we pay more not just for less, but for nothing.

But what if we twisted our ankle and went directly to that specialist and paid out of pocket a transparent price? What would it take for that to happen? Not much, the cost of care is predictable, and because payments have always been decreasing, most physicians have learned to be economical. Plus, out of pocket costs are capped by federal law, so no patient is really responsible for catastrophic bills. Charges inflate to cover overhead, but if payments were guaranteed and immediate, then the cost of doing business goes down.  Add technologies like telemedicine to a practice and you have increased patient access to a doctor without adding more personnel.  Direct pay doctors are emerging all over the country and have consistently offered better access and more affordable care. The bar is also being set by independent surgery centers and imaging centers who offer better outcomes at lower costs. Perhaps motivated by prohibitive pricing, better options have emerged that have moved patients away from expensive operating rooms to safe, office-based procedures.  Even cutting-edge cancer therapies can be delivered at home, preserving more of the healthcare dollar for medical care rather than the complex system built to manage it.

Competition and choice inevitably drive prices, but in a monolithic system the price is not negotiated, but instead it is set by only a few, in this case the big insurers.   Small businesses cannot compete when bigger companies come to town.  Eventually, the local hardware store gives way to a national brand, and the consumer is left with fewer choices and eventually higher prices.  Amazon disrupted this equation by creating a marketplace for individual buyers and sellers.  The convenience of finding a trusted brand, no longer available locally, is irresistible and the reason why we became loyal consumers.  Healthcare is no different. Trust exists implicitly between a physician and patient, because it is an authentic, empathetic, and logical relationship. Trust does not exist between a patient and their insurer, on the contrary it is an unsympathetic business relationship without transparency or consistency. Few doubt the insurance company’s top priority is the premium, not the patient.  Creating a direct relationship between the doctor and patient is a common-sense approach that serves both stakeholders well, and requires merely a fair and affordable price.  But do doctors have the capability or the will to do it and if so, can the rest of the system follow?

Never in the history of modern medicine have physicians been more dissatisfied.  US healthcare used to lead the world in innovation and outcomes, now we struggle to break the top thirty. We may have the most brilliant doctors and scientists with access to the best resources, but the need to maximize profits while catering to special interests, be they commercial or political, has led us to favour certain therapies over others despite marginal proven benefits. Doctors have little autonomy and less authority; prescribed treatments are routinely denied by insurance companies without a second thought or appropriate peer review.  In fact, insurers even renamed us “providers”, a term used to by Nazis when referring to Jewish doctors to devalue them professionally.  Over 56% of physicians are burned out, nearly all report moral injury and as hospitals have systematically replaced doctors with non-physicians with limited training, we have watched the standard of care deteriorate. It is no wonder we have witnessed the single biggest loss in life expectancy since WWII. The prognosis is grim, but there are solutions.

We need to reinvent healthcare by removing the middleman.  We don’t have to set the price, but we can make it transparent so patients can decide for themselves if it is worth the inconvenience, the delay, and the co-pay to use insurance or just pay directly.  Health savings accounts are tax deferred and can cover an out-of-pocket maximum in just a couple of years. Paying for care means there are no surprise bills or out of network costs, because there are essentially no networks and therefore no need to follow restrictions.  You’d be hard pressed to find a doctor or hospital unwilling to accept an immediate cash payment, especially when it costs nothing more than the service provided.  There are no billing cycles, or claims to prepare, no up coding, or authorizations.  Doctors free to care for patients, patients treated individually and not subject to protocols designed to maximize charges. There are literally thousands of direct pay primary care and specialists now available all over the country and they are building alliances with likeminded people providing imaging, ancillary services, surgery centers, and prescriptions all at fair market prices.  More and more employers are moving toward medical cost sharing plans that not only lower the cost of care but the cost of administration.  Even the biggest payor, namely the government, sees the benefit of price transparency and is piloting models of direct contracting. 

We will always need coverage for those unexpected events, emergencies, or hospital-based services, but all the rest - doctor visits, screening tests, and outpatient procedures - are easily affordable.  After all, do we use our car insurance to pay for an oil change? If we did, the cost would be prohibitive and few of us would drive. But health insurers have lost our trust, they no longer cover necessary services and no longer honour contracts with physicians or patients.  It is time to offer another option and let the patients and doctors get back to the real business of medicine.

Spotlight

Sheikh Khalifa Medical City

Encompassing several ‘Centers of Excellence’, Sheikh Khalifa Medical City, managed by Cleveland Clinic, serves as the flagship institution for SEHA's healthcare system. It is governed by its commitment to practice modern medicine to the same high standards as the best medical facilities in the world.

OTHER ARTICLES
DIGITAL HEALTHCARE

The digital hospital of the future

Article | June 4, 2022

​As the cost of care continues to rise, many hospitals are looking for long-term solutions to minimize inpatient services. Learn how technology and health care delivery will merge to influence the future of hospital design and the patient experience across the globe in this report developed by Deloitte US. Five use cases for the digital hospital of the future The future of health care delivery may look quite different than the hospital of today. Rapidly evolving technologies, along with demographic and economic changes, are expected to alter hospitals worldwide. A growing number of inpatient health care services are already being pushed to home and outpatient ambulatory facilities. However, many complex andv very ill patients will continue to need acute inpatient services. With aging infrastructure in some countries and increased demand for more beds in others, hospital executives and governments should consider rethinking how to optimize inpatient and outpatient settings and integrate digital technologies into traditional hospital services to truly create a health system without walls. To learn what this future of health care delivery may look like, the Deloitte Center for Health Solutions conducted a crowdsourcing simulation with 33 experts from across the globe. Participants included health care CXOs, physician and nurse leaders, public policy leaders, technologists, and futurists. Their charge was to come up with specific use cases for the design of digital hospitals globally in 10 years (a period that can offer hospital leaders and boards time to prepare). The crowdsourcing simulation developed use cases in five categories Redefined care delivery Emerging features including centralized digital centers to enable decision making (think: air traffic control for hospitals), continuous clinical monitoring, targeted treatments (such as 3D printing for surgeries), and the use of smaller, portable devices will help characterize acute-care hospitals. Digital patient experience Digital and artificial intelligence (AI) technologies can help enable on-demand interaction and seamless processes to improve patient experience. Enhanced talent development Robotic process automation (RPA) and AI can allow caregivers to spend more time providing care and less time documenting it. Operational efficiencies through technology Digital supply chains, automation, robotics, and next-generation interoperability can drive operations management and back-office efficiencies. Healing and well-being designs The well-being of patients and staff members—with an emphasis on the importance of environment and experience in healing—will likely be important in future hospital designs. Many of these use-case concepts are already in play. And hospital executives should be planning how to integrate technology into newly-built facilities and retrofit it into older ones. Technology will likely underlie most aspects of future hospital care. But care delivery—especially for complex patients and procedures—may still require hands-on human expertise. Laying the foundation for the digital hospital of the future ​Building a digital hospital of the future can require investments in people, technology, processes, and premises. Most of these investments will likely be upfront. In the short term, hospital leadership may not see immediate returns on these investments. In the longer term, however—as digital technologies improve care delivery, create operational efficiencies, and enhance patient and staff experience—the return result can be in higher quality care, improved operational efficiencies, and increased patient satisfaction. These six core elements of an enterprise digital strategy can help you get started as you begin to push your hospital into the future Create a culture for digital transformation It is essential that senior management understands the importance of a digital future and drives support for its implementation at all organizational levels. Consider technology that communicates Digital implementation is complex. Connecting disparate applications, devices, and technologies—all highly interdependent—and making certain they talk to each other can be critical to a successful digital implementation. Play the long game Since digital technologies are ever evolving, flexibility and scalability during implementation can be critical. The planning team should confirm that project scope includes adding, modifying, or replacing technology at lower costs. Focus on data While the requirements of data interoperability, scalability, productivity, and flexibility are important, they should be built upon a solid foundation of capturing, storing, securing, and analyzing data. Prepare for Talent 2.0 As hospitals invest in exponential technologies, they should provide employees ample opportunities to develop corresponding digital strategies. Maintain cybersecurity With the proliferation of digital technologies, cyber breaches can be a major threat to hospitals of the future. Executives should understand that cybersecurity is the other half of digital implementation and allocate resources appropriately.

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HEALTH TECHNOLOGY

AI in Healthcare Businesses: From Efficient Uses Cases to ROI Growth

Article | May 30, 2022

It’s no secret now that healthcare is an in-demand field. Today, business leaders need modern and intelligent decision-making solutions for their customers and clients. They must also focus on the right investment areas and learn the tricks for investing, spending, and setting goals for revenue generation to accelerate business. With continuous developments in the healthcare sector, integrating AI into processes can help increase ROI. Therefore, if you, like any other business leader, are looking for solutions to empower your services and products in the healthcare domain, this article will help you through AI’s ultimate use cases and churn out a higher ROI. What’s with AI in Healthcare at Present? AI’s role in healthcare is evolving and enhancing traditional business operations, particularly marketing. According to a study by IBM, 71% of customers expect real-time communication. Thus, global demand is fueling the rising adoption of AI marketing solutions. The effects of AI in healthcare are evident. Gartner reports increased marketing efficiency and effectiveness (86%), improved decision-making (71%), better data analysis and new insights (79%). Global AI spending will rise from $450 million in 2019 to over $28 billion by 2024 is not surprising. Similar and further studies are ongoing on various use cases of AI in healthcare at scale. What are the efficient use cases of AI that will help healthcare businesses boost their ROI? Let’s find out. How is AI Applied in Healthcare? The promising applications of AI in healthcare to improve outcomes are very intriguing. While there is still much to achieve in the AI-dependent healthcare business, there is sufficient potential that tech companies are willing to invest in AI-powered tools and solutions. Let’s examine the potential examples of AI in healthcare to prepare and support business strategies accordingly and foster higher ROI generation. Predictive Analytics AI-based predictive analytics impacts a business by automating administrative tasks, predicting sales outcomes for a year, customers’ behavior and making strategies accordingly. According to a Forbes study, AI-based predictive analytics can save businesses $18 billion in tasks, expenses, and pricing. To understand this, one example of using AI to automate admin tasks is a collaboration between the Cleveland Clinic and IBM. Cleveland Clinic uses IBM’s Watson to mine big data and provides personalized services for customers and clients on marketing deeds. Some of the practical applications of AI and predictive analytics in healthcare are: Monitoring market trends to maximize marketing efforts Organizing datasets Creating marketing campaigns tailored to each demographic-based client Mining collective data for future decision-making Fraud Prevention AmerisourceBergen Corp detects fraud and misleading business operations through AI. A sales account team conducts audits with AI to detect usual lea and queries to prevent hefty expenses for businesses. The example explains that implementing AI in your process will help detect any significant fraud attempts inside your business operation. This will help your business save huge expenditures. Boost Sales By putting down false leads, AI helps in maximizing sales numbers, resulting in significant ROI generation. For example, AI transforms data into personalized data, which reduces the cost of operations. Chatbots Most healthcare businesses leverage chatbots on their websites to engage more and more customers and boost engagement. In this way, businesses tend to gain multiple leads and convert them into clients by providing the best marketing solutions. Chatbots are fruitful for AI start-ups in healthcare—small businesses can deploy AI to their websites. By doing so, they can save millions in administrative costs and attract numerous leads. The most prominent examples of AI in healthcare hail from giant tech titans such as IBM, Amazon, and Microsoft. They are assisting healthcare providers with AI to create and deploy digital-human employees. Segmentation of Marketing Targets Is your target audience not responding to your marketing campaigns (for example, by not clicking a link, subscribing or unsubscribing to a newsletter, or not registering for a medical event)? If that's the case, how should you go ahead? Using AI-based tools allows your marketing to easily identify target behaviors and reactions based on the type of marketing actions to be carried out. Analyzing these actions can help segment targets based on your company's marketing objectives. The most significant development took place in April 2022, when Amazon Alexa became fully HIPAA compliant. It works with health developers and service providers that manage protected information for customers. AI Leads to Data Modernization It’s all about the data—not any data! There’s a precise association between AI and data management, resulting in data modernization. According to a Cognizant research study, healthcare leaders have made significant progress in modernizing their data. In contrast, most upcoming businesses are expecting to do so by 2024. The maximum acceleration of AI in modernizing data will be seen in the manufacturing and marketing of healthcare products and services, respectively. It is because AI helps to churn data easily. The accessibility of data, in particular, becomes simpler with automation than doing it manually, which generates a massive amount of data. Such effects of AI in healthcare can be one of the prime reasons for the higher ROI of your business in the future. “There has never been a greater need for skilled analytic talent in health care. Because AI is becoming more strategic, organizations must ensure access to this skill set, either by growing their analytic teams or seeking out experienced partners." Steve Griffiths, CEO of Optum Enterprise Analytics AI Expenditure is on the Rise McKinsey says that by 2025, the use of AI in healthcare will be widespread, resulting in significant expenditure by global healthcare leaders. AI is a significant concern for healthcare decision-makers, investors, and innovators as customers extensively engage and react to AI-powered services and solutions. AI is constantly bringing improvements to almost all processes, including cost savings, management of services and products, and monitoring of multiple operations. Even small businesses in the healthcare industry are proactively investing in AI applications to match steps with the current wave of innovation in healthcare services. Accelerate ROI Using AI AI in healthcare is becoming one of the prime responsible technologies for accelerating ROI. Technology can eradicate multiple business growth challenges. Let’s find out how. Enhanced Performance As previously stated, use cases of AI in healthcare can relieve stress on employees. This would allow them to devote their time to more value-added marketing activities to churn more ROI. Emphasize Cost-Effectiveness Most of the businesses associated with healthcare are concerned about the costs involved. With AI, they now develop policies to spend less on non-essential activities and necessitate profit-oriented actions. "We believe in the potential of AI to deliver insights and operational efficiencies that unlock better health-care performance." Robert Musslewhite, CEO at OptumInsight Frequently Asked Questions How is AI used in healthcare? AI in healthcare automates and predicts processes by analyzing data throughout. It is used to predict potential customers, improve business management workflows, and manufacture medical products. How does AI drive growth in the healthcare industry? AI drives business growth by improving the ability to understand better day-to-day customer patterns and needs based on services and products. How is AI changing the Healthcare industry? AI applications in healthcare have demonstrated their potential to improve analytics and data management and assist service providers in making timely medical decisions.

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HEALTH TECHNOLOGY

Wearable Technology is the New Healthcare!

Article | May 18, 2022

Do you know you can now wear technology? With the help of wearable technology, it's now easier to keep track of useful information in one go! This go-to technology has made people’s lives easier and smoother health-wise. In the last five years, more people have started using wearable technology to monitor health data and live healthier lifestyles. According to the Deloitte Global Survey, today, more than 80% of people are interested in using wearable technology. Statista also studied that the ear-worn wearable technology market will be worth more than 44.16 billion US dollars by 2023. These data show that customers are gravitating toward wearable technology due to its simplicity and convenience. The Tech is Getting Smarter Wearable technology has enabled the concept of self-checking, evaluation and monitoring of certain health conditions. The Internet of Things (IoT) technology is transforming and improving the entire lifestyles of millions of people. So it's no surprise that the technology is spreading. Thanks to IoT and AI, which have pushed these technologies into individuals’ hands in the form of smartwatches, fitness bands, and other devices. In this case, app development has also been a critical success factor. Consumers of all age groups actively use wearable technology for multiple physical benefits, such as monitoring daily activities (running, walking), water intake, heartbeat, sleep cycles, blood pressure, oxygen level, and mobility levels. In fact, the tech helps them to stay motivated by maintaining and extending their good habits. Wearables can measure these characteristics through an effective data model that is instantly responsive. The readings can be saved, displayed, or forwarded to a doctor for medical study. This interface of wearable technology saves money and time traveling to clinics, hospitals, GPs, and other medical facilities. The next feature that only wearable technology provides is reminders and inspiring information! Due to the addition of automatic functionalities, users have invested considerably in wearables and sparked the usage at the current time. Furthermore, wearable technology is also seen in other medical devices such as ECG monitors, which is again a cutting-edge consumer electronic device that users can use to measure electrocardiograms at home. A Deloitte study found that due to the rising demand and supply together, nearly 200 million wearable gadgets will be marketed globally by 2023. Transforming Healthcare Towards Intelligence The pandemic accentuated the importance of wearable technology the most, particularly for health monitoring. As a result, the technology was available in every second home. Wearable innovation is exceptional with the advancements in sensors, artificial intelligence, machine learning, and algorithms. Sensor data provides insights regarding an individual's activity levels, cardiac pattern discrepancies, and other aspects. For example, many companies and manufacturers employ PPG, Raman spectroscopy and infrared spectrophotometers to enable blood pressure monitoring features in smartwatches and portable medical devices. The combination of technology with intelligence is creating a whole new world of healthcare where individuals can track, record, and improve their health issues in a lesser timeframe. A Committed Future of Healthcare So, will technology for health improvement thrive? The answer is yes. Wearable technology delivers real-time health data and allows consumers to improve their health without incurring high costs. Consumers' willingness to share their data with healthcare professionals indicates a surge in future demand for wearable technology gadgets.

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HEALTHCARE ANALYTICS

Importance of Mental Health for Sustainable Development

Article | May 11, 2022

Mental illness is a fatal illness. Surprisingly, mental health is grossly underfunded all over the world. Despite countries' economic strength, there are still no long-term and solution-driven results for addressing mental health. According to WHO reports, only one in every fifty people receives medical treatment for severe mental illnesses. The Sustainable Development Goals (SDGs) are a global initiative to create a more equitable and sustainable world. According to the World Health Organization, "there can be no health or sustainable development without proper mental health." As a result, mental health is one of the most critical pillars in creating a sustainable world in the future. In short, if mental health is good, sustainability will follow naturally. Positive Mental Health = Thriving Sustainability According to the WHO’s decision-making body, ‘The World Health Assembly (WHA),’ mental health deserves to be at the top of the sustainability agenda because it affects people of all ages. It means anybody can be diagnosed with a mental illness, which is directly proportionate to sustainable development. So, a similar amount of treatments, diagnoses, and awareness should help people overcome mental illness. However, on the other hand, according to the WHO's 2020 Mental Health Atlas, only 23% of patients with mental illnesses have been integrated into healthcare systems in developing countries. This highlights the undeniable fact that the world's 280 million people suffering from depression have been kept away from receiving a proper diagnosis, treatment, and care. Moreover, up to 85% of people with mental illnesses are untreated. The numbers are shocking! Such statistics are enough evidence to create a supportive culture free of the stigma that mental illness is incurable and encourage patients to seek help when they need it. It includes geography-specific mental health resources, proper diagnosis, care, medication, availability, accessibility, other requirements, and adequate support systems. Global Action is Key to Both Providers of mental health services cannot do it alone. Instead, it requires a strong global response. In this case, leading companies and legislative bodies should exert influence to promote cost-effective, widely accessible, and evidence-based treatments for mental health disorders. Some low-cost solutions to this global problem will eradicate it and bring about long-term development to support this point. As a result, the solutions are as follows Improving social and economic environments as part of sustainable development Integrating mental health into general primary health care Providing appropriate care and treatment through trained and supervised community members Using technology to introduce the most up-to-date solutions for mental health disorders Wrapping Up Transformation is essential today, both technically and in terms of humanizing. Otherwise, sustainable development will be impossible to achieve unless the enormous challenge of mental health is addressed. Therefore, healthcare leaders will need to develop transitional plans to increase coverage in real-time to accomplish this. This should include proper diagnosis and progressive tracking of mental health treatments.

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Spotlight

Sheikh Khalifa Medical City

Encompassing several ‘Centers of Excellence’, Sheikh Khalifa Medical City, managed by Cleveland Clinic, serves as the flagship institution for SEHA's healthcare system. It is governed by its commitment to practice modern medicine to the same high standards as the best medical facilities in the world.

Related News

INSURANCE

As One Insurance Group Launches Population Health Strategy That is Revolutionizing Healthcare

As One Insurance Group | February 25, 2022

Privately-held insurance brokerage firm As One Insurance Group ("As One") has announced the launch of its population health strategy that is already revolutionizing the healthcare industry based in Phoenix, As One has quickly achieved benchmark status in the population health world. Brandon Bullock, Chief Strategy Officer of As One, says, "Over the years we have seen the number of those without access to healthcare shrink, the numbers are a positive sign, 10 percent of Americans still have no access to care. We're looking to close that gap. As One is offering Health Navigator alongside its proprietary sales platform which leverages electronic processing to speed up the sales cycle." The cutting-edge firm specializes in life, health, and ancillary insurance benefits and is making insurance simple for carriers, agents, and clients through distinct offerings including: An innovative population health strategy A proprietary sales platform and CRM for straight-through electronic processing An impressive nationwide distribution channel Advanced agent training and sales tools "With the right tools at their fingertips, our team and agents show tremendous courage every day fighting to fix health insurance, a strong team that works as one." J.R. Jordan, Chief Executive Officer of As One Cost of Healthcare in America The cost of Healthcare in the United States is a significant factor that prevents people from obtaining the necessary care or filling prescriptions. Half of U.S. adults have stated that they postponed or completely mitigated some sort of dental or health care in the past year due to the high cost. Three in 10 people have also reported not taking their necessary medicines as prescribed at some point due to the very same reason. High healthcare costs excessively affect uninsured adults and those with lower household incomes. Larger shares of U.S. adults have also reported difficulty affording different types of care, which further delays and attributes to them forgoing medical care due to the cost. However, individuals that are covered by health insurance are not immune to the weight of healthcare costs. Almost half (46%) of those insured reported difficulty affording out-of-pocket expenses, and 27% had reported difficulty in being able to afford their deductible. Difficulty paying medical bills has resulted in significant consequences for U.S. families. Medical bill problems are also disproportionately affecting those adults in households where they or a member of their household has a severe health condition. About As One Insurance Group As One Insurance Group ("As One") is a privately held insurance brokerage based in Phoenix, Arizona, specializing in life, health, and ancillary insurance benefits. As One aims to simplify insurance by making the process straightforward and honest. With transparent product information and open communications being the norm, the company provides a range of life and health insurance products that are coupled with the tools agents and clients need to manage their needs. That includes advanced education and training, innovative technology solutions, and best-in-class service. In short, they work with and for agents, clients, and carriers together as one.

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INSURANCE

Exela Expands PCH Global Solution with Leading Healthcare Insurer

Exela Technologies | January 12, 2022

Exela Technologies, Inc. (“Exela”)today announced that it continues to expand its relationship with a leading health insurance organization that spans almost two decades. This customer continues to accelerate deployment of Exela’s PCH Global platform to speed up their digital transformation and improve both the member and provider experience. The latest expansion is valued at $6.2 million of additional contract value revenue. Exela continues to invest in expanding PCH Global’s capabilities to provide a cloud hosted solution with one of the best edit resolutions for healthcare claims. This extension of deployment marks another milestone in the value proposition of the PCH Global platform to digitally connect members, providers and insurance companies to enable clean claims, payment transparency and digital appeals. PCH Global’s cloud network also offers increased scalability, the highest uptime and best business continuity protections. PCH Global has robust data analytics which are continually improving as Exela processes more and more data. Additionally, PCH Global’s improved data analytics can be accessed via a self-service model. “We are proud of our long standing partnership and privileged to be part of customer’s digital transformation journey. Adoption of our PCH Global platform continues to address healthcare industry’s goal to deliver most efficient, cost effective and best healthcare to the members.” Suresh Yannamani, President of Exela About Exela Technologies Exela Technologies is a business process automation (BPA) leader, leveraging a global footprint and proprietary technology to provide digital transformation solutions enhancing quality, productivity, and end-user experience. With decades of experience operating mission-critical processes, Exela serves a growing roster of more than 4,000 customers throughout 50 countries, including over 60% of the Fortune® 100. Utilizing foundational technologies spanning information management, workflow automation, and integrated communications, Exela’s software and services include multi-industry, departmental solution suites addressing finance and accounting, human capital management, and legal management, as well as industry-specific solutions for banking, healthcare, insurance, and the public sector. Through cloud-enabled platforms, built on a configurable stack of automation modules, and over 17,500 employees operating in 23 countries, Exela rapidly deploys integrated technology and operations as an end-to-end digital journey partner.

Read More

INSURANCE

As One Insurance Group Launches Population Health Strategy That is Revolutionizing Healthcare

As One Insurance Group | February 25, 2022

Privately-held insurance brokerage firm As One Insurance Group ("As One") has announced the launch of its population health strategy that is already revolutionizing the healthcare industry based in Phoenix, As One has quickly achieved benchmark status in the population health world. Brandon Bullock, Chief Strategy Officer of As One, says, "Over the years we have seen the number of those without access to healthcare shrink, the numbers are a positive sign, 10 percent of Americans still have no access to care. We're looking to close that gap. As One is offering Health Navigator alongside its proprietary sales platform which leverages electronic processing to speed up the sales cycle." The cutting-edge firm specializes in life, health, and ancillary insurance benefits and is making insurance simple for carriers, agents, and clients through distinct offerings including: An innovative population health strategy A proprietary sales platform and CRM for straight-through electronic processing An impressive nationwide distribution channel Advanced agent training and sales tools "With the right tools at their fingertips, our team and agents show tremendous courage every day fighting to fix health insurance, a strong team that works as one." J.R. Jordan, Chief Executive Officer of As One Cost of Healthcare in America The cost of Healthcare in the United States is a significant factor that prevents people from obtaining the necessary care or filling prescriptions. Half of U.S. adults have stated that they postponed or completely mitigated some sort of dental or health care in the past year due to the high cost. Three in 10 people have also reported not taking their necessary medicines as prescribed at some point due to the very same reason. High healthcare costs excessively affect uninsured adults and those with lower household incomes. Larger shares of U.S. adults have also reported difficulty affording different types of care, which further delays and attributes to them forgoing medical care due to the cost. However, individuals that are covered by health insurance are not immune to the weight of healthcare costs. Almost half (46%) of those insured reported difficulty affording out-of-pocket expenses, and 27% had reported difficulty in being able to afford their deductible. Difficulty paying medical bills has resulted in significant consequences for U.S. families. Medical bill problems are also disproportionately affecting those adults in households where they or a member of their household has a severe health condition. About As One Insurance Group As One Insurance Group ("As One") is a privately held insurance brokerage based in Phoenix, Arizona, specializing in life, health, and ancillary insurance benefits. As One aims to simplify insurance by making the process straightforward and honest. With transparent product information and open communications being the norm, the company provides a range of life and health insurance products that are coupled with the tools agents and clients need to manage their needs. That includes advanced education and training, innovative technology solutions, and best-in-class service. In short, they work with and for agents, clients, and carriers together as one.

Read More

INSURANCE

Exela Expands PCH Global Solution with Leading Healthcare Insurer

Exela Technologies | January 12, 2022

Exela Technologies, Inc. (“Exela”)today announced that it continues to expand its relationship with a leading health insurance organization that spans almost two decades. This customer continues to accelerate deployment of Exela’s PCH Global platform to speed up their digital transformation and improve both the member and provider experience. The latest expansion is valued at $6.2 million of additional contract value revenue. Exela continues to invest in expanding PCH Global’s capabilities to provide a cloud hosted solution with one of the best edit resolutions for healthcare claims. This extension of deployment marks another milestone in the value proposition of the PCH Global platform to digitally connect members, providers and insurance companies to enable clean claims, payment transparency and digital appeals. PCH Global’s cloud network also offers increased scalability, the highest uptime and best business continuity protections. PCH Global has robust data analytics which are continually improving as Exela processes more and more data. Additionally, PCH Global’s improved data analytics can be accessed via a self-service model. “We are proud of our long standing partnership and privileged to be part of customer’s digital transformation journey. Adoption of our PCH Global platform continues to address healthcare industry’s goal to deliver most efficient, cost effective and best healthcare to the members.” Suresh Yannamani, President of Exela About Exela Technologies Exela Technologies is a business process automation (BPA) leader, leveraging a global footprint and proprietary technology to provide digital transformation solutions enhancing quality, productivity, and end-user experience. With decades of experience operating mission-critical processes, Exela serves a growing roster of more than 4,000 customers throughout 50 countries, including over 60% of the Fortune® 100. Utilizing foundational technologies spanning information management, workflow automation, and integrated communications, Exela’s software and services include multi-industry, departmental solution suites addressing finance and accounting, human capital management, and legal management, as well as industry-specific solutions for banking, healthcare, insurance, and the public sector. Through cloud-enabled platforms, built on a configurable stack of automation modules, and over 17,500 employees operating in 23 countries, Exela rapidly deploys integrated technology and operations as an end-to-end digital journey partner.

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