The growing use of AI by payers to manage claims and denials raises ethical and practical challenges for hospitals. As contract renewals approach, hospitals should negotiate terms that prioritize transparency and accountability. 1️⃣ Advocate for Shorter, Flexible Contracts: Shorter contracts (one-two years) allow hospitals to adapt to evolving AI technologies and regulatory changes. If your current contract has significant time remaining, consider exploring an addendum to address these concerns. 2️⃣ Demand Transparency in AI Use: Push for contract terms requiring payers to disclose their AI use in claims processing. Set expectations for transparent AI protocols and manual reviews for complex cases. 3️⃣ Include Other Essential Provisions: ✅ Advance notice of provider manual updates that could affect contract terms (e.g., readmission timeframes) ✅ More granularity around the 4201 requirements ✅ An appeals process before plans can recoup funds Read more in our latest blog, "Navigating Medicare Advantage: Strategies for Hospitals to Tackle Growing Challenges": https://lnkd.in/eEv-QGd9
About us
EvidenceCare is a new type of clinical decision support system (CDSS) with its EHR-integrated and content-agnostic platform that empowers better care decisions by improving clinical workflows. Founded in response to the professional experience of emergency physician Dr. Brian Fengler, the platform provides clinicians with evidence-based insights and measurable outcomes. Based in Nashville, Tennessee, EvidenceCare is one of the top INC 5000 fastest growing healthcare tech companies and has won multiple awards for its innovative products and platform.
- Website
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http://www.evidence.care
External link for EvidenceCare
- Industry
- Embedded Software Products
- Company size
- 11-50 employees
- Headquarters
- Brentwood, Tennessee
- Type
- Privately Held
- Founded
- 2016
- Specialties
- Evidence Based Medicine, Healthcare, Healthcare Technology, and Software for EMR
Locations
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Primary
155 Franklin Rd
Suite 160
Brentwood, Tennessee 37027, US
Employees at EvidenceCare
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Matt Rhodes-Kropf
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Scott Kolesar
Co-Founder & Managing Partner @ Caduceus Capital Partners, LLC | Healthcare VC
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David Vreeland
Senior Managing Partner @ Caduceus Capital Partners, LLC | Healthcare Venture Capital
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Heather Sunshine DiVerde MS, MBA, CMR
Vice President, Business Development
Updates
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Jacqueline Kimmell breaks down the challenges Medicare Advantage plans are facing with new policy changes. These shifts are creating significant revenue headwinds. Some health systems with at-risk contracts could see declines of 20-30% in the next few years. Learn how to navigate these challenges—listen to episode 22 of The Better Care Podcast! #BetterCarePodcast #HealthcarePolicy #MedicareAdvantage
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To kick off 2025, we pulled together our Top 5 Articles of 2024. These articles are full of insights and strategies on Medicare Advantage challenges, AI in healthcare, tips for compliant documentation, and more to help set you up for success in the year ahead. Check them out in our latest newsletter! #MedicareAdvantage #HealthIT #AIinHealthcare
Get Ahead in 2025 With Our Top Articles from 2024...
EvidenceCare on LinkedIn
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On The Better Care Podcast, William Haugh from LifePoint Health shares his take on AI in healthcare. While it’s been a buzzword over the past year, he points out the challenge of finding real-world applications. What’s your take - how do you think AI will shape healthcare by 2025? #BetterCarePodcast #AIinHealthcare #HealthcareInnovation
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On The Better Care Podcast, Melinda Hancock explains how prioritization works at Sentara Health. With thousands of potential initiatives, decisions are guided by: ➡️ Safety ➡️ Quality ➡️ Resource constraints She highlights the importance of a portfolio management approach to provide visibility across all projects, enabling better prioritization, resource allocation, and even the ability to pause or combine initiatives when needed. Curious how leaders tackle complex organizational transformation? Listen to episode 19 of The Better Care Podcast! #BetterCarePodcast #HealthcareTransformation #CTO
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We’re hiring! Are you looking for your next challenge? We're searching for a Client Success Executive to drive client success, build strong partnerships, and make a meaningful impact in healthcare. We offer: ➡️ Competitive salary + stock options ➡️ Unlimited PTO ➡️ Medical, dental, vision, and life insurance ➡️ 401k plan Does this role sound like the right fit for you? Apply here: https://lnkd.in/ecZJ_m_2 #NowHiring #ClientSuccess #EvidenceCare
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Happy Holidays from EvidenceCare! As we wrap up 2024, we want to thank all our clients, partners, and employees who make what we do possible. Your hard work and commitment to better care inspire us every day. We hope this holiday season brings you joy, rest, and time with the people who matter most. Cheers to everything we’ve accomplished together in 2024 and to an even better 2025! #HappyHolidays
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What a year! This team made 2024 one to remember, and we can’t wait to cheer each other on in 2025. Here’s to a great year ahead! #2024Recap #Teamwork #SeeYouin2025
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Let’s see who knows the Christmas classics! 🎅 #ChristmasQuotes #TeamChallenge #OfficeFun #CompanyCulture
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Where is value-based care today? On The Better Care Podcast, Adam Kaufman shared that most healthcare systems are still operating under a fee-for-service model. While roughly 20% of payments are tied to value-based care, much of it remains upside-only bonuses. The shift is happening, but it’s slow. Listen to the full interview with Bo Bartholomew and Adam Kaufman on The Better Care Podcast! #ValueBasedCare #BetterCarePodcast #HealthEconomics #HealthcareInnovation #FeeForService