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Cyber Threat Intelligence (intel) is an important component of our security operations strategy. We believe it is critical to gather intel from multiple trusted sources and use it as a force multiplier. Our security operations team uses this data across multiple tools in our security portfolio. Enabling us to proactively identify and prevent cybersecurity incidents.

Industry Intel Feeds

While we have multiple Intel sources, one of our most valuable is the Health Information Sharing and Analysis Center (H-ISAC). H-ISAC is comprised of critical infrastructure operators and owners within the Health and Public Health sector, that share information in real time such as indicators of compromise (IOCs), tactics, techniques and procedures (TTPs), best practices, recommendations, as well as mitigation strategies. In additional to intel feed access, our H-ISAC membership also provides resources such as white papers, information and awareness videos, sector relevant news, and more.

Automated Endpoint Defense

Utilizing the data from our intel feeds, we can leverage automation to proactively update our endpoint controls to block communication with potentially risky sites and prevent malicious downloads from even reaching the machine. We can update our firewalls with ever changing list of malicious and suspicious IP addresses. We are also able to leverage these feeds while triaging security events from the endpoint, to determine if a file, process, or action needs to be quarantined or blocked. This streamlined process not only cuts down response time, but also ensures timely remediation and a complete review of the detection.

Automated Log Detection

Log sources from endpoints, firewalls, and network access points are collected and stored for analyses. Log collection allows us to categorize log events into different severity levels. Rules are then set on these events to trigger a notification to the security operations team, and other alerting tools in order to perform a remediation. Because logs are fed into a single source, if one malicious event is detected, our security operations team is able to quickly determine the scope of the detection. The scope analysis can identify changes in permissions, leaked credentials, and other events that would be considered changes in normal behavior. If abnormal behavior is detected for a specific user, additional steps would trigger to reflect the increased risk.

Bringing It All Together

When multiple intel feeds are used, HealthEdge is able to validate intel and make informed decisions on how to keep our network safe. We don’t rely on a single source for intel, but rather take full advantage of reputable external resources and internal resources that provide us with a complete picture. Our goal is to bring all the information together to ensure our security strategy is comprehensive and robust.

 

As it has been in the last several years, 2023 has significant regulations in play – predominantly revolving around interoperability and transparency, making it strategically critical for health plans to understand the life cycle of their data. Enrollment data, Provider Contracting & Participation data and Cost Sharing transparency will all see changes in the next few years. It is no longer enough to simply have the data and extract it – health plans need to understand where data comes from and how it’s used. They need to completely understand what data is being extracted, the intent of the data, and how it’s being reported and how it is presented to their members.

Data Granularity & Health Equity

The Covid-19 pandemic shined a glaring light on inequity in health outcomes. We knew that social economics plays a role in health outcomes, but we weren’t looking at race, ethnicity, and other stratifications or at least not at the right level of granularity. For example, during Covid, health outcomes for those of African American descent were dramatically less – regardless of economic level.

It is critical that we look at the data in more granularity – and look at race, ethnicity, gender, and gender identity. We need to identify outcomes and start improving them. We need to ensure that some segments of society aren’t being undermanaged or underserved due to insufficient/too broad data.

Race & Ethnicity Stratification

Health plans are required to report race and ethnicity. However, we’ve never separated the two, meaning a patient would be listed as Black and Hispanic. By getting more granular with the data – for instance by separating these two data points we can improve individual and population health.

Another example – today, a patient would be listed as multi-race/Hispanic. But what if we got more granular and note that this patient is Puerto Rican, Black, and Hispanic. With this more granular data, we can start to see what needs to be improved, such as better communication methods or increased education. We can approach patients with more knowledge gleaned from this data granularity and improve care.

Currently, there are no codes for Middle Eastern descent – but we know that people of Middle Eastern descent have their own genetic markers. What information could we glean from this population if that code and subsequent data existed? How could it improve the health of this population?

Protecting Sensitive Data

There remains a hesitancy in some parts of the population to share their information. Race, sexual orientation, and gender identity can be sensitive topics to certain members of the population, and with this sensitivity sometimes comes a hesitancy to share this information. For instance, SOGI has been hit or miss around transgender and how transgender people are treated.

This is a stumbling block we need to acknowledge and manage. We need to be sensitive to the increasingly granular data we store, its sensitivity, societal triggers, and patient/populations outcome/treatment. We need to protect this data and keep vulnerable populations safe/comfortable to share their information.

Federal & State Regulations

Health plans need to get to the level of granularity required by these regulations.

In 2023, NCQA’s health plan ratings include commercial, Medicare, and Medicaid health plans. The rating is a weighted average of a plan’s HEDIS® and CAHPS® measure ratings and accreditation status as of June 30, 2023.

Furthermore, in 2023, HEDIS is requiring additional reporting stratification  for  five key measurements:

• Colorectal Cancer Screening
• Controlling High Blood Pressure
• Hemoglobin A1c Control for Patients with Diabetes
• Prenatal and Postpartum Care
• Child and Adolescent Well Care Visits.

HealthEdge – Enabling Transparent Data

The member centric goals of interoperability and transparency efforts hinge upon the industry’s approach to understanding data characteristics, from the business perspective, beyond data mapping and formatting. As regulations evolve and standards are adopted, we begin to see alignment of data standards and transaction formats for these data elements.

The HealthEdge suite of products is so adaptable – it can create the mechanism to allow our customers to collect, store, use, and extract the data in any way necessary to improve their member health and meet regulatory compliance requirements.

Learn more about HealthEdge’s accurate, real-time data here.

Have you ever gotten a phone call or meeting request where you were told that you were getting a new boss, being moved into a different role, or even that your entire department was going to be reorganized? The immediate feeling of dread and then so many questions popping into your head about why this is happening or how this will impact your future. We all have experienced these types of situations in the workplace. It feels like a roller coaster ride. Change is inevitable in any organization and can be deeply disruptive, but in the remote work environment we now operate in it can be even more so. People leaders need to recognize the challenges of leading their teams through the change from afar. Read on to find out more about how to create an environment that encourages remote employees to embrace change and watch your change initiatives become easier to execute.

 

1. Be Clear about the Reasons for Change

People leaders must provide clarity when introducing change. Employees need context and details to understand why a change is taking place, what value it will bring, and how they will be affected by it. When this information is shared with employees promptly, they’ll have an opportunity to provide feedback or ask questions BEFORE the changes go into effect. This helps ensure that everyone involved understands the reasons behind the changes, which can help them feel more engaged and motivated throughout the process.

 

2. Encourage Open Communication

Open communication is essential when navigating remote change management. People leaders should make sure their team members understand their expectations and are comfortable communicating with each other and with leadership throughout the process of implementing new changes. Encouraging honest conversations between everyone involved in making decisions can also help ensure that everyone is on the same page. Additionally, ensuring that employees have opportunities to access different avenues of communication such as 1:1, team meetings, email, or other communication platforms such as Slack or Teams can help foster collaboration and allow for smoother transitions during times of disruption.  In addition, communicating change is not just a one-and-done process, it is multiple times in many ways and often repeating yourself. You must remember you have been planning this change for a while and they are just now hearing about it so being consistently repetitive is important. And don’t forget to prepare your managers who are critical to change initiatives being successful.

 

3. Build Trust

People leaders should strive to create an environment of trust throughout the transition period, as well as afterward. This means being transparent about why certain decisions were made and why certain changes are being implemented. Leaders should also take time to listen carefully to their team’s concerns while providing thoughtful answers in response—this helps build trust among team members while fostering a sense of community during times of upheaval. Team members will go through a variety of emotions such as anger, disbelief, disengagement, and acceptance as they experience the change. People leaders should always strive to show empathy towards their team members; this will help them understand that their feelings are valid even if they don’t agree with every decision made by leadership.

 

In conclusion, navigating change in a remote work environment requires patience, understanding, open communication, empathy, and trust—all qualities people leaders must possess if they want their teams to embrace changes without feeling overwhelmed or isolated during periods of disruption. By following these tips and actively engaging with team members during times of transition, people leaders can create an environment where individuals feel supported no matter where they work from!

Technology use among seniors saw significant gains over the last several years, fueled in part by a desire to stay connected during the COVID pandemic. A research study performed by AARP showed 84% of adults over the age of 50 own smartphones, up from 77% in 2019. Ownership of other devices, including tablets, smart TV’s, home assistants, wearables, and smart home technologies, have seen double-digit increases among the same population since 2019.

Technology as a Lifeline

A report from the National Academies of Sciences, Engineering, and Medicine (NASEM) points out that nearly one-fourth of adults aged 65 and older are socially isolated. Older adults are at increased risk for loneliness and social isolation because they are more likely to experience the loss of family or friends, chronic illness, or hearing loss.

Living alone, a reality for approximately one in three older adults living in the US, is another factor impacting loneliness and social isolation. Despite this, three out of four of the adults surveyed want to stay in their homes and age in place as told by Susan Beaton, VP of Health Plan Strategy at Wellframe,  in the webinar How health plans can enhance engagement with senior members using technology. For these seniors, technology can help them connect to family, friends and even healthcare providers.

During the COVID pandemic, technology became a lifeline for everyone, but the senior population likely made the biggest strides in usage and adoption. Technology became, and continues to be, a lifeline for aging Americans – whether it’s meeting their emotional needs by connecting with loved ones or helping to enhance their medical care through virtual appointments and other digital interactions with their healthcare providers.

Increased Health & Wellness

The ability for seniors to adopt technology and leverage health-related innovations may lead to positive effects on their health and wellness. The opportunities for these gains, while seemingly small, can add up to make a big impact in overall health.

• Utilization of wearables might encourage seniors to be more active and can clue them into changes in heart rate, blood pressure, temperature or even sleep quality – alerting them earlier to potential health issues.
• Managing and adhering to medications can be challenging for aging adults, but technology can help to issue reminders and monitor usage and even alert caregivers when a dose is missed.
• Telehealth usage peaked over the last years and continues to be an option for delivering healthcare services to older adults in a convenient and cost-efficient manner. Virtual visits mean fewer trips outside the home, less exposure to Covid-19 and other illnesses, and better chances of being seen sooner.

Increasing Technology Use for Seniors

Engaging seniors through technology can be challenging and requires unique approaches to overcoming hurdles. There may be a learning curve to new technology and some individuals may feel overwhelmed. Seniors living on fixed incomes may not have the financial resources to purchase new technologies. Despite this, many payer organizations who recognize the benefits are finding innovative solutions to ensure the members they serve have the tools they need to engage.

The Right Platform: Wellframe

The Wellframe digital health management platform powers health plans and senior members to achieve their best. It helps organizations extend their reach across more critical touchpoints, uncover, valuable health insights, and deliver modern member services that improve member engagement and experience. Learn more here.

At HealthEdge, we keep a close eye on the market and the drivers that are influencing healthcare. Our team looks to the experts at Gartner and KLAS, surveys our clients to understand what they’re doing, engages with client’s clinical staff to understand how they use our tool set, and monitors the marketplace to meet the needs of our customers.

These are the top 3 care management trends we’re seeing:

1. Doing more with less

Remaining competitive in today’s market means optimizing healthcare operations so clinicians can remain focused on caring for member populations.

One of the trends in the healthcare industry is the decrease in people entering the profession, especially nurses, which is going to lead to a significant shortage. This is further compounded by the Great Resignation and high turnover rates which add to the shortage. At the same time, we’re seeing an increase in the number of people who are developing a chronic illness, which is driving the need for us to make our tools much more efficient so we can care for members. With less staff – especially in a value-based environment – we need tools to help health plans do more with less.

One of the things we’re excited about at HealthEdge is our digital care member outreach platform. This helps your clinical staff be far more efficient by putting some of the work that the care manager does in the hands of the member to enable their own engaged, active participation in managing parts of the care management continuum.

Source: 20% nurse shortage, 171 million people with one chronic condition

2. Increasing Demand for Interoperability

Another trend we’re seeing is an increased demand for interoperability among solutions. Regulatory pressures, the shift to digital health, and new payer-provider business models underscore this growing need.

The main drivers include:

1. Government agencies such as CMS are continuing to push payers and providers to increase the interoperability between their systems. This is to reduce administrative burden and errors, as well as improve the overall member experience.
2. We’re also seeing a lot more collaboration demand between payers and providers. This is driving a lot of data exchange requirements, such as integrating our solutions with electronic health records, and building real-time interfaces with our clients’ data infrastructure so that we can exchange data between these systems in real time.
3. The underpinning of all of this is an explosion of health technology.

3. The Importance of a Modern Platform

Payers are embracing next-level platforms with connected ecosystems and real-time data insights that impact cost and quality outcomes. According to a recent McKinsey article, Cloud capabilities have the potential to generate value of $100b to $170b in 2030 for healthcare companies.

There are five healthcare categories that benefit from cloud technology:

By 2024, healthcare providers that have adopted a Digital Health Platform will outpace competition by 80% in the speed of digital transformation and new feature implementation.

HealthEdge: The Right Platform

To remain viable in the evolving industry, health plans must lean into the above drivers and opportunities, rather than ignoring them. Thus, you need the right platform underlying your systems, and you need to take some steps to build a strong foundation that aligns with where the market is heading.

This is the thesis of HealthEdge and the GuidingCare team – to build a digital health plan ecosystem with best of breed products: core admin (HealthRules Payer®), care management (GuidingCare®), prospective payment integrity (Source), and member experience (Wellframe).

 

 

 

Payer organizations today face significant obstacles as they navigate a new era of member and provider “relationship management.” Members and customers have increased expectations and payers are responding by working towards executing transactions more quickly and identifying incorrect payments and their root causes.

While the spectrum of payment integrity is broad, the goals of all segments are to encourage the affordability of healthcare by preventing poor quality claims upfront, avoiding downstream costs where possible, and recovering improperly spent funds postpay when necessary.

However, trying to achieve these goals is challenging for the average payer organizations due to the following factors:

• Fragmentation within payer organizations requires top-down leadership to break the cultural, technical and organizational silos.
• Quantifying the value of education and prevention is difficult.
• Coordinating workflows across internal organizations is a large challenge.

Prepay vs Postpay in Healthcare: Advantages of Shifting Towards a Prepay Model

Moving “left” from postpay to prepay allows payers to have more predictive control and addresses the challenges payer organizations face. While doing so can be organizationally and culturally challenging, there are many benefits and advantages of this shift:

• Increasing accuracy of claims reimbursement and transparency of payments, leading to improved provider relations
• Removing redundant tasks, reducing staff frustration, saving time
• Decreasing claim spend
• Improving claim denial rate
• Reducing the number of claims requiring rework
• Lowering the cost per claim processed
• Reducing the significant claims-related provider inbound call volume
• Improving the member and provider experiences
• Identifying and educating providers by revealing patterns of poor payment integrity practices

An Alternative Approach to Payment Integrity

As the landscape of healthcare payer technologies evolve, an alternative approach to payment integrity is emerging: single, one-stop-shopping solutions. Source, HealthEdge’s payment integrity software, is a single payment integrity solution that offers a centralized repository of data that can be used for multiple functions, such as claims reimbursement, editing, clinical reviews, modeling and analytics. Transitioning to a single-solution system offers payers the opportunity to streamline operations, form authentic vendor partnerships, and take control of a comprehensive approach to their claims payment operations. Learn more about partnering with Source, a transformative, single-solution partner.