healthcare payers

There are many things in this world that make us happy and bring us joy. Sometimes when those great things are combined with other wonderfully, great things they become AMAZING! Simply put…they are Better Together. Here are a few of those amazing things:

  • Peanut butter and jelly
  • Milk and cookies – especially chocolate chip!
  • Netflix and your couch
  • Danny and Sandy
  • Wine and Cheese
  • Fall and pumpkin spice everything!

This list can go on and on. I’m sure you already thought of 5 more. What does this have to do with the healthcare industry? What comes to mind when you hear payer and provider? By themselves they are good. Payers enable us to pay for checkups that keep us healthy. Providers take care of us when we are sick and payers help us pay for that care. Payers and providers go hand and hand. So why aren’t they always “Better Together”? The good news is they can be. With a few strategic initiatives focusing on increased collaboration the old saying of “two heads are better than one” will hold true.

When payers and providers don’t collaborate, the patient suffers. They end up dealing with challenges from both sides. How many times have you dealt with multiple bills, billing errors or hidden costs followed by phone call after phone call in an effort to correct the problem? It’s a cycle that becomes very frustrating. Payers and providers need to join forces and coordinate efforts that will drive improved service and positive patient outcomes. What good is Netflix without a couch to cozy into? When a team approach is put in play it will inevitably lead to better patient experiences, increased quality of care and financial wins for both sides.

Sharing data is an important first step. Technology offers payers and providers a plethora of options to improve access to data and transparency into processes. The use of online portals and automated solutions encourages communication while promoting better efficiency and accuracy. We live in a technology driven world, so why shouldn’t payers and providers take advance of new technologies that will drive them to better heights.  Payer and provider collaboration, and a strategy to become Better Together, is key to improving patient satisfaction and delivering better health outcomes.

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New CMS Guidance

  As part of an initiative to streamline the Medicare Advantage and Prescription Drug appeals and grievance processes, CMS has consolidated Chapter 13 of the Medicare Managed Care Manual and Chapter 18 of the Prescription Drug Benefit Manual into one comprehensive guidance document. They are doing this to better align and provider a more defined, straightforward and non-repetitive understanding of […]

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Your Best Teacher Is Your Last Mistake

5…4…3… 2…1 🚀, it’s time to move forward and discover the power of you! This is the message behind the 5 Second Rule by Mel Robbins. It’s a cool, powerful self-help concept I was introduced to while listening to Mel speak recently at Hyland Software’s CommunityLive event in Nashville, TN. Embracing that concept I say 5…4…3… 2…1 it’s time to […]

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How Painful is Your Contracting Process?

Does your contracting process take forever? Can it take weeks, even months to bring a contract from creation, through negotiation and finally to execution? What causes the bottlenecks and how can they be fixed? First, let’s identify some common hurdles within the contracting process. Once identified, we can implement a contracting management solution to address those issues and reduce contracting […]

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Why CommunityLIVE 2018? So Much More Than Just A Conference…

It was over ten years ago when Hyland took over Nashville and I last took the general session stage at CommunityLIVE (at that time called the OnBase Training & Technology Conference). For those that don’t know my background, I started my career in Content Services at Hyland as a Product Evangelist. This year will be my 12th CommunityLIVE. Now, I […]

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August 31, 2017

Things That Are Better Together

There are many things in this world that make us happy and bring us joy. Sometimes when those great things are combined with other wonderfully, great things they become AMAZING! Simply put…they are Better Together. Here are a few of those amazing things: Peanut butter and jelly Milk and cookies – especially chocolate chip! Netflix and your couch Danny and […]
July 12, 2017

Uncertainty…How are you handling it?

Studies have shown that most people would rather be unhappy than uncertain. But when you are unhappy, you are less motivated, more stressed and may just feel lost. Why would you want to feel that way? And doesn’t that seem worse than being uncertain? Plus, how you deal with uncertainty can define your path towards happiness and overall success! So […]
March 16, 2016

Gateway Health(SM) Selects Kiriworks Appeals & Grievances Solution

Appeals & Grievances solution supports Gateways belief in “A Better Way” Milwaukee, WI, March 15, 2016 – Gateway Health, a top ranked Medicaid and Medicare managed care organization has been delivering quality and affordable healthcare to its members for over 20 years. In concert with Gateway’s strong commitment to doing things “A better way” the selection of Kiriworks as their […]
April 29, 2015

Appeals & Grievances: 3 tips for the daily triathlon

Last year I completed my first triathlon. Reflecting on the event, I realized that Appeals & Grievances (A&G) managers run a triathlon every day. Triathlons include three events in succession and it’s all about the clock. In an Olympic Triathlon – like I participated in – you start with a one-mile swim, transition to a 25-mile bike ride and finish with […]