AUTHOR: Gordon MacMaster

Recent Posts

AI and machine learning revolutionize the health insurance industry

AI and machine learning revolutionize the health insurance industry

Health insurance policy changes at the federal level have captured the headlines in recent years, but in the long run some of the most profound changes to the industry have happened behind the scenes. The application of artificial intelligence and machine learning have impacted some of the industry’s most important practices.

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How to manage overall cost recoveries? 5 ways to recover

How to manage overall cost recoveries? 5 ways to recover

While Coordination of Benefits (COB) and fraud, waste and abuse (FWA) have been a part of the insurance industry for almost as long as there’s been an insurance industry, they’ve taken on a new level of importance for today’s health insurers. Outdated, inefficient and ineffective COB and FWA processes can result in higher payouts, increased administrative costs and decreased customer[…]

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Why health plans lose money on payment integrity programs

Why health plans lose money on payment integrity programs

Health plans make large investments to automate outdated processes when it comes to claims payment integrity expecting significant savings. Unfortunately, with this approach the expected savings don’t always materialize.

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Why is it so hard for health plans to find quality data analytics solutions?

Why is it so hard for health plans to find quality data analytics solutions?

While healthcare is famously complex, it shouldn’t be as hard as it is for health plans to find and manage advanced analytics solutions that take advantage of their unique opportunities and address their specific challenges.

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10 Health Insurance Trends for 2019

10 Health Insurance Trends for 2019

For an industry that has undergone immense change in recent years, 2019 looks to be more of the same for health insurance. Some of the pressures come from standard sources such as governments, employers and providers, while others are driven by broader demographic or technological trends. Whatever the root cause might be, health insurers will continue to value adaptability, cost containment[…]

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