Insights shaping the future of prior authorization, utilization management, and healthcare technology.
Explore expert perspectives, industry trends, product innovations, interoperability developments, AI advancements, and operational best practices from the teams helping modernize healthcare workflows across Health Plans, PBMs, and healthcare organizations.
How AI is reshaping prior authorization workflows.
Learn how AI-powered automation, OCR, NLP, and intelligent clinical review capabilities are helping organizations reduce manual work and improve operational efficiency.
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Elevating Security Standards: The Significance of HITRUST Certification in Healthcare Vendors
Ensuring the security and confidentiality of patient data is paramount. Healthcare vendors play a crucial role in maintaining the integrity of sensitive information. One key aspect that highlights a commitment to robust security practices is achieving HITRUST...
ChatGPT Produces Unreliable Results in Recent Pharmacy Studies
Per a recent article posted by MedPage Today, researchers revealed that "ChatGPT provided incorrect or incomplete information when asked about drugs, and in some cases invented references to support its answers, two evaluative studies found. In the first, 39 questions...
Navigating Opioid and Controlled Substance Programs in Healthcare
Addressing the opioid epidemic requires more than just awareness—it demands strategic and efficient solutions. Health Plans and PBMs play a crucial role in curbing this crisis, and Agadia's RxSentinel+ is at the forefront, empowering organizations to configure and...
Empowering Health Plans and PBMs to Address the Prior Authorization Burden: Insights from Medical Groups
In response to the recent report from the Medical Group Management Association (MGMA), it's evident that the prior authorization process remains a significant challenge for medical groups, impacting patient care and straining operational efficiency. The report...
Optimizing Electronic Medical Prior Authorizations: The Transformative Power of PAHub
Efficiently processing medical prior authorizations is crucial for Health Plans and Pharmacy Benefit Managers (PBMs) seeking to enhance operational efficiency and improve patient outcomes. In this blog post, we'll explore the importance of streamlined eMPA workflows...
Democrats Express Concerns About CMS’s Prior Authorization Requirements and the Use of AI-Driven tools
As per an article published last Friday, House Democrats are pressuring the Centers for Medicare & Medicaid Services (CMS) to better evaluate how artificial intelligence is utilized by Medicare Advantage (MA) plans, hoping to prevent eye-catching rates of denial....
Agadia Announces Game Changing Solution for Grievance Management
Agadia is delighted to introduce GrievancesHub - a cutting-edge web-based resolution system engineered to redefine Grievance Management for Health Plans and Pharmacy Benefit Managers (PBMs). Live demos will begin this December. We invite you to schedule a demo and...
The Human Touch in Healthcare Technology: Navigating the AI Revolution
Technological advancements in the Healthcare industry have become synonymous with progress. The surge of AI technology in healthcare is not only revolutionizing patient care but also reshaping how healthcare operations are conducted. While AI is indeed a powerful...
Setting the Course for Success in 2024: Enhancing Medication Therapy Management Programs
As we approach 2024, it's an ideal time to set new goals and strategies for your Medication Therapy Management (MTM) programs. In this blog post, we'll explore key considerations for enhancing your MTM programs to meet the needs of your members, fulfill CMS...
What Is Utilization Management In-House? How Health Plans Benefit
Health plans continually face the challenge of delivering high-quality care while managing costs and ensuring regulatory compliance. One crucial area where they can make a significant impact is in the realm of utilization management programs. It's led many health...