Providers utilize business intelligence to monitor referral patterns and collaborate with clinicians who order their services. Such analytics tools have also been deployed in the specialty to improve productivity, track patient satisfaction and bolster quality.
The state is accusing the insurer of colluding with the broader Blue Cross Blue Shield network to stifle competition and control prices. BCBSM denies the allegations.
The hack, which was revealed earlier this year in a report from Bleeping Computer, is said to have been limited to a legacy server. Oracle denied its cloud environment had been compromised.
Independence Blue Cross, the largest medical insurance provider in the Philadelphia area, does not admit to wrongdoing. It was accused in a lawsuit backed by the U.S. Department of Justice of misrepresenting the severity of patient illnesses to juice risk-adjusted Medicare payments.
With its $350M in new funding, EliseAI said it plans to build out its technology and sales force. It currently works with specialty provider groups to automate practice operations such as scheduling and insurance verification.
The study from the American Medical Association is based on data from commercial and Medicare Part D plans. The analysis found market share for PBMs is heavily concentrated, leading to higher drug costs.
The 2016 payout totaled $770 million, with $71 million going to executives at Steward Health Care. That year, the hospital chain reported a net loss of $300 million.
Baltimore sued eight companies that it claimed profited off the city’s opioid epidemic. To date, the government has received $402.5 million in settlements.
