Payers and providers have for too long been at odds when determining medical necessity. Without a shared framework for making level of care determinations, reimbursement and care remain misaligned. Standards are only effective if they are accepted and adhered to by all parties. Traditional criteria have not adapted to the changing needs of today’s healthcare system; however, real-time predictive analytics serve as a neutral framework to bridge the divide between payer and provider.
Most analysts of the U.S. healthcare system believe poor integration of care and services is a primary driver of high health care spending ….
NEJM Catalyst Marketplace Survey
By using analytics to aid clinicians and nurses in overcoming operational hurdles, hospitals understand and undertake their care and compliance continuum more fully, while payers lessen their administrative burden and costly adjudication efforts.