Researching the Market for Fraud, Waste and Abuse Detection in Claims Data

As part of my graduate assistantship at the Center for Health Information and Decision Systems (CHIDS), I have been researching vendor solutions in the market for prevention and detection of Fraud, Waste and Abuse (FWA) in healthcare billing claims, also called anomalous claims.  My analysis is related to a larger effort at CHIDS to evaluate […]Continue reading «Researching the Market for Fraud, Waste and Abuse Detection in Claims Data»

On the Way Towards Healthcare Transparency

“When you go shopping for a car, you know its price: it’s right there on the window, and there are numerous sources for information about key aspects of quality,” says Giovanni Colella, CEO and co-founder of Castlight Health, at the U.S Senate Committee on Finance on June 18,  “But when it comes to the health […]Continue reading «On the Way Towards Healthcare Transparency»

Health Decision Systems: Unleashing Data and Creating Jobs

Earlier this week Matthew Yglesias covered research presented at last week’s 2nd Forum of the European Society for Radiotherapy and Oncology; the findings suggest that some mathematical models could be better than doctors at predicting patient outcomes and responses to various treatments. In turn Mr. Yglesias hypothesized that advances in the area of algorithmic diagnosis […]Continue reading «Health Decision Systems: Unleashing Data and Creating Jobs»

The Patient Engagement Index from Axial Exchange, a New Measure of Patient-Centered Care

On April 4th, Axial Exchange, a health IT company based in Raleigh, North Carolina, launched its PEI (Patient Engagement Index), a ranking of major hospitals in Florida. Rankings for hospitals in other states will release in upcoming months. Among the 74 hospitals ranked, the top three are also the only ones with scores in the […]Continue reading «The Patient Engagement Index from Axial Exchange, a New Measure of Patient-Centered Care»

Increasing returns in health care fraud and abuse investigations – future prospects

The Health and Human Services (HHS) Department has recently announced that in the fiscal year (FY) 2012, the government’s health care fraud prevention and enforcement efforts recovered a record $4.2 billion in taxpayer dollars. It was $4.1 billion in FY 2011. These figures get us to a return on investment of $7.90 for every $1 […]Continue reading «Increasing returns in health care fraud and abuse investigations – future prospects»

Top 5: Health Care Innovation Awardees

Five organizations that have won a Health Care Innovation Award from the Center for Medicare and Medicaid Innovation for their proposed health IT intervention: Comprehensive community-based approach to reducing inappropriate imaging (Altarum Institute): aiming to reduce unnecessary imaging studies, they plan to create a data-exchange system between primary care and imaging facilities. The Bronx Regional […]Continue reading «Top 5: Health Care Innovation Awardees»

Top 5: Health IT Projects from the California Healthcare Foundation

The California Healthcare Foundation (CHCF) is a nonprofit grantmaking organization with a $700 million endowment. Here are its five most recent Health IT projects:     1.) Rural Inpatient Telepharmacy Consultation Demonstration for After-Hours Medication Review: a project that used telepharmacy to help rural hospitals to cope with staffing shortages and reduce medication errors (instead of […]Continue reading «Top 5: Health IT Projects from the California Healthcare Foundation»

Top 5: Medicare Review Contractors (tasked with cutting fraud and waste in the program)

The Office of National Coordinator for Health IT (ONC) reports that in 2009 the Medicare fee-for-service program made an estimated $34.3 billion in improper payments and the Medicaid program made an estimated $22.5 billion in these payments. Medicare Review Contractors compare the claims submitted by Medicare providers against entries in medical records with the goal […]Continue reading «Top 5: Medicare Review Contractors (tasked with cutting fraud and waste in the program)»

Top 5: Health IT Funding Opportunties

1.) Centers for Medicare and Medicaid Services (CMS) Meaningful Use Program: incentive payments to professionals and eligible hospitals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology 2.) Agency for Healthcare Research and Quality (AHRQ) Health IT Research Grants: ongoing health IT funding opportunities focused on design and safety 3.) National […]Continue reading «Top 5: Health IT Funding Opportunties»

CMS Explores Granting Patients Greater E-Info Access

The Centers for Medicare and Medicaid Services (CMS) recently proposed to give patients electronic access to laboratory test results – marking another potential step toward health information transparency. That news comes from an interesting post by Health Date Management blogger Greg Gillespie, who writes that “Patients should have full rights to the data generated and […]Continue reading «CMS Explores Granting Patients Greater E-Info Access»