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...


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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...

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...

Da Vinci Project Brings HL7 FHIR to Payers for Big Data Analytics

by Jennifer Bresnick

In just a few short years, HL7 FHIR has exploded in popularity to enable unprecedented connectivity across the healthcare ecosystem.    The internet-based data standard has started to hit...