Waste Accounts for 25% of Health Care Spending. Addressing Fraud and Abuse Can Help.

It already hurts to hear that the United States spends more on health care than any other country, with costs approaching 18% of the gross domestic product and more than $10,000 per individual.

A report published last week in The Journal of the American Medical Association makes those numbers even more painful as it reveals the estimated cost of waste in the United States ranges from $760 billion to $935 billion, accounting for approximately 25% of total health care spending. This amount exceeds national military spending, as well as total primary and secondary education spending.

(more…)

Continue Reading

Go Beyond the Cloud with Rachel Wang

Meet Rachel Wang, a data scientist at Softheon.

Born in the province of Shendong in northeastern China, Rachel came to the United States to pursue education and professional development. She already studied mathematics and economics at a college in China but sought further mastery in mathematics. Thinking mathematically comes easily to her and she enjoys how “every problem is a math problem.”

(more…)

Continue Reading

Don’t Leave Money on the Table: Five Steps to Addressing SDOH

PricewaterhouseCoopers Health Research Institute recently released their new report: “Action Required: The Urgency of Addressing Social Determinants of Health.” Anyone in health care eager to save on costs and create efficient medical interventions should review this report. This piece provides a review of report, highlighting the five steps PwC recommends taking to lead in social determinants of health (SDOH).

(more…)

Continue Reading

Let the Data Speak for Itself: The Relationship Between Work and Health

Both before and after the Centers for Medicare and Medicaid Services’ (CMS) policy reversal on work requirements, stakeholders have debated whether employment leads to improved health outcomes. CMS and states that have implemented or are trying to implement work requirements argue they do, while others disagree. The recent research of the Kaiser Family Foundation (KFF), a nonpartisan organization, illuminates what the data says on the relationship between work and health. This piece provides a recap of KFF’s findings.

(more…)

Continue Reading

CMS Continues Mission on Integrity with Affiliations Final Rule

Last week, the owner and CEO of Video Doctor Network pled guilty to a $424 million Medicare kickback scheme. He admitted to receiving kickbacks and bribes from recruiters, pharmacies and brace suppliers in turn for arranging doctors to order medically unnecessary orthotic braces for Medicare beneficiaries. As reported by Healthcare Dive, this is one of the largest schemes to defraud Medicare ever investigated by the Federal Bureau of Investigation (FBI) and the Health and Human Services (HHS) Office of the Inspector General and prosecuted by the Department of Justice.

(more…)

Continue Reading

Product Talk: Enhanced Direct Enrollment

Softheon’s private-label enrollment solution, Enhanced Direct Enrollment-as-a-Service (EDE) offers a unified enrollment experience and an updated, easy-to-use portal for Marketplace members. Now available to any health plan engaged in the ACA Marketplace once it informs CMS that it is partnering with Softheon as an EDE vendor, Softheon EDE uses a series of Centers for Medicare and Medicaid Services-based (CMS) application program interfaces (APIs) to process eligibility and changes behind the scenes. In this interview, we spoke with Min Kyu Han, one of EDE’s product owners. 

(more…)

Continue Reading

HMA Conference Recap

The Health Management Associates (HMA) conference brought together hundreds of industry executives from health plans, governments and community-based organizations serving Medicaid, Medicare and vulnerable populations. Set in Chicago, Illinois, the conference shed a light on the challenges and opportunities for health care entities in the publicly sponsored health care arena.

In case you were not able to attend, here is a recap of the key topics discussed:

(more…)

Continue Reading
Close Menu