Blog

As health plans and providers transform operations to support value-based care, it’s important to keep in mind that successfully engaging consumers in their health is also critical to managing costs and outcomes.

Healthcare organizations need to be ready now to successfully tackle New York State’s ambitious 1115 Waiver data exchange goals. Learn more.

As your organization delves into the intricacies of the 2025 Final Rule and Rate Announcement, remember that proactive adaptation is vital.

The Jiva Care Quality Navigator is a transformative tool that empowers healthcare providers to deliver high-quality, patient-centered care. Learn more.

Learn more about Population Health Management tools including what they are, who they are for, and how insights can be gathered from the data collected.

The CMS 2025 Medicare Advantage Advance Notice proposes changes to Star Ratings measures and the V28 Risk Adjustment Model. Learn more.

ZeOmega is revolutionizing member engagement with its comprehensive suite of capabilities comprising the Jiva Member Engagement Navigator solution.

From the patient and provider perspective, prior authorization can feel like a burden, but its purpose is to promote quality care and to decrease wasteful spend.

The CMS released its Interoperability and Prior Authorization final rule (CMS-0057-F). Learn what this means for payers and providers.

Finding a delicate balance between cost control and preserving quality care is critical for healthcare payers and managed care organizations.

Recent ONC announcements will have a significant impact on payers, providers, and health information technology (HIT) vendors in 2024. Learn more.

Learn why payer-provider collaboration via data exchange is necessary, how it can help to increase care coordination, and how it can be done securely.

Get an overview of key OIG findings, tips for MAOs to avoid similar pitfalls, and what to expect in 2024 with the updated risk adjustment model.

With the right combination of continuous operational scrutiny and performance management solutions like the Jiva Care Quality Navigator, plans can improve.

With utilizing AI in healthcare, we must analyze LLMs, the inputs, and the outcomes as we continue to evolve them with discretion and critical thinking.

Improve risk adjustment accuracy with Jiva's Risk Adjustment Navigator, a comprehensive solution that can increase financial success and quality care.

To effectively navigate the complexities of risk adjustment in federally sponsored healthcare, a combination of operational strategies and technology is vital.

With the Jiva platform's configurable Sentinel Rules Engine (SRE), health plans can use automation to effectively prioritize, sort, and manage the case load.

For federal authorities, reducing risk adjustment overpayments and noncompliant coding practices are critical to the sustainability of the healthcare system.

Patient Access and Interoperability bring hundreds of payers and app developers into an emerging ecosystem that will continue to mature.

Learn how current risk adjustment methodologies have unintentionally caused overpayments for federally sponsored healthcare funding.

Learn why API testing & certification programs confirm the ability to fully conform to the FHIR standard and enable interoperability in a scalable manner.

Learn how risk-adjusted data allows organizations to compare costs, project revenue, and evaluate network performance equitably to identify opportunities.

ZeOmega blog series on risk adjustment looks at where we’ve been, what we’re facing today, what’s on the horizon, and how to best prepare. Over the next several blogs, our ZeOmega risk adjustment solution experts will provide a forecast of regulatory changes and guidance on ensur

See how new technologies enable nurse informaticists, health plans, providers, and community-based resource organizations to improve processes.

ZeOmega is kicking off a new blog series on risk adjustment to look at where we’ve been, what we’re facing today, what’s on the horizon, and how to best prepare. Over the next several weeks, our ZeOmega risk adjustment solution experts will provide a forecast of regulatory change

FHIR stands for Fast Healthcare Interoperability Resources. Learn about FHIR-based APIs hosted by payers and how this impacts access to health information.

See how new technologies enable nurse informaticists, health plans, providers, and community-based resource organizations to improve processes.

Let's take a look ChatGPT, what is unique about it, why it’s different this time, and the potential benefits in healthcare.

For any areas of healthcare where blocks of text are present, ChatGPT can offer a myriad benefits. See more.

We are living in turbulent times. On global and local levels, threats of force, and actual violence, are present almost everywhere we look. While many of us are fortunate or even privileged, no one with a conscience can ignore and not be troubled by the events around us.

Medicaid is the largest health insurance program in the U.S., covering approximately one in five Americans. That equates to 82.3 million low-income Americans, including millions of children, older adults, people with disabilities, and two million veterans. Medicaid is the single

Claw Backs and Beneficiary Protections in the Form of CMS Regulatory Changes – Massive Financial Implications

Much of the direction of the 2020 proposed rule is in the new proposed rule, particularly the sharing of prior authorization decisions/status with patients.

The Centers for Medicare and Medicaid (CMS) released the 2024 Medicare Advantage Proposed Rule on December 14, 2022 and the 957 page document is scheduled to enter the federal register on December 27th, 2022.

To reduce the burden of the prior authorization, many providers and payers have come together to develop solutions. Learn more.

Contact rates for case managers were better than 50%, yet actual enrollment in our programs was less than 10%.

Learn more about putting AI to work for your healthcare organization’s member engagement strategies.

Measure year 2022 saw record-breaking numbers of Medicare Advantage (MA) health plans achieving five-Star Ratings, but with pandemic adjustments—which focused on pre-COVID-19 data.

The prior authorization process is often viewed as a burden by providers, necessitating staff resources and delaying care. Generally, the experience is considered abrasive.

There has been a lot of talk about the cost of care, but what really is the “cost of care,” and can it be reduced? I propose striving to reduce the cost of care is a misunderstood concept.

What’s the difference between customization and personalization, and what does that have to do with enterprise-grade population health management applications?

Common wisdom holds that data is the critical component of population health. The key to success, however, comes from identifying relationships and meaning within the data that affect both broad populations and individuals within those populations.

One of the most significant challenges for population health programs is understanding how to connect macro-level population health patterns to engage people within those populations.

opulation health initiatives aim to help patients maintain optimal health and ultimately save money by managing and preventing disease.

It’s no secret that the Quadruple Aim – healthcare’s holy grail of reducing costs, improving population health, enhancing patient engagement, and improving the experience for healthcare providers.