By Jocelyn Keegan, Payer Practice Lead Payer interest is growing in electronic prior authorization (ePA). Initially, in many organizations, automation largely replicated the paper process requiring duplicate entry of information. …
By Michael Burger, EDI Practice Lead CDS Hooks are a new SMART on FHIR technology that will enable providers to receive timely information about individual patients, their condition and potential …
By Jocelyn Keegan, Payer Practice Lead, and Ken Kleinberg, Innovative Technologies Practice Lead The Center for Medicare and Medicaid Services (CMS) recently announced a proposed rule that would require use …
By Pooja Babbrah, Practice Lead, PBM Services Specialty medications are changing health care, providing life-saving treatment options for patients with rare and chronic conditions. Patients, however, often face big hurdles …
By Ken Kleinberg, Practice Lead, Innovative Technologies CAQH’s (Council for Affordable Quality Healthcare) recently released their new Phase V CORE Operating Rules for prior authorization (PA) that improve on specificity …
By Pooja Babbrah, Practice Lead, PBM Services The CARIN Alliance—a large, multi-stakeholder coalition–has formed a workgroup aimed at advancing the consumer-facing, real-time pharmacy benefit check (RTPBC). The goal is to …
By Pooja Babbrah, PBM Services Practice Lead In mid-March, I was invited to testify in front of the U.S. Senate Special Committee on Aging at a hearing they held focused …
By Tony Schueth, CEO & Managing Partner How we pay for health care is undergoing a disruptive, fundamental shift. We rapidly are moving away from the traditional fee-for-service, pay-for-volume approach …
By Tony Schueth, CEO and Managing Partner Specialty medications are high-cost, complex drugs with special handling and delivery requirements. They are primarily used to treat rare or chronic conditions. Retail …
by Tony Schueth, CEO & Managing Partner A growing number of medications require prior authorization (PA) before they can be dispensed. This is a concern among providers, who are very …
