Podcasts about healthedge

In this episode of Breaking Health, guest host Payal Agrawal Divakaran, partner at .406 Ventures, speaks with Jeremy Friese, CEO of Humata Health, about prior authorization and how Humata is helping from “both sides of the fax machine.” Friese also discusses his thoughts on the future of AI adoption, how the regulatory landscape looks, and more. He also shares what the transition between physician to entrepreneur was like, what it's like to found and grow companies, and how to select the right VC partners. Links from this episode:  HealthEdge  .406 Ventures Humata Health  

Startups increasingly depend on mergers and acquisitions for exits due to a sluggish IPO market. Private equity firms have invested over $56 billion in acquiring private, venture-backed companies in the past five years. In 2023, private equity firms announced 22 acquisitions of seed- or venture-funded private companies, with three deals revealing a total of $8.3 billion. Notable recent transactions include ModMed's $5.3 billion sale to Clearlake Capital Group and HealthEdge's $2.6 billion acquisition by Bain Capital. Private equity firms prefer to buy established companies with substantial revenue, often resulting in acquisitions of mature startups. Seed-stage companies are less likely to attract private equity interest, as they face more favorable exit opportunities from strategic industry buyers. Although public PE firm valuations have declined, significant numbers of later-stage companies, with 789 private, venture-backed firms in the U.S. valued over $1 billion, present opportunities for acquisitions. Many of these firms have seen reduced valuations since their market peak four years ago, making them attractive for private equity acquisitions.Learn more on this news visit us at: https://greyjournal.net/news/ Hosted on Acast. See acast.com/privacy for more information.

In this episode of the Becker's Healthcare Podcast, Jakob Emerson is joined by Rob Duffy, CTO at HealthEdge, to discuss the evolving role of platform-based technology in healthcare. They explore how interoperability, regulatory changes, and change management strategies are shaping the future of health plans. Tune in for expert insights on overcoming technological silos, preparing for innovation, and navigating the complexities of the healthcare ecosystem.This episode is sponsored by HealthEdge.

In this special video episode of Breaking Health / In this episode of Breaking Health, guest host Payal Agrawal Divakaran, partner at .406 Ventures, speaks with Kristina Saffran, cofounder and CEO of Equip about providing accessible eating disorder treatment for patients everywhere. Saffran shares the origins of Equip, busts some myths surrounding eating disorders, and explains how her company pays for health plans. She also discusses the importance of working with the right cofounders, picking the right VC partners, navigating rough patches, fundraising, and more. Divakaran and Saffran also share their thoughts on contemporary topics and trends in the industry in a lightning round. Links from this episode:  HealthEdge .406 VenturesEquip 

Description: In today's podcast, we explore how optimizing provider data management (PDM) is key to boosting operational efficiency for health plans. Parvathy Sashidhar, Senior Director of Product Management for HealthEdge, dives into the common challenges plans face with outdated provider information and how these issues can be mitigated. Learn how advanced PDM solutions can streamline data integration and ensure accurate provider details, ultimately improving care delivery and strategic growth.This episode is sponsored by HealthEdge.

In this episode, we are joined by two guests from HealthEdge, Steve Krupa, CEO, and Ryan Mooney, Executive Vice President and General Manager of Payment Integrity, to discuss the gaps in payment integrity, the difference between prospective payment integrity and traditional payment integrity, and a lot more. This episode is sponsored by HealthEdge.

Tesla CFO departure, RBI chairman's slip-up, Intel's expansion plans, Stirista's trademark complaint against Skydeo, Cathay Pacific's profit turnaround, HealthEdge's new investment fund, DoorDash's surge in non-restaurant orders, AMC Theaters' sales increase, and the importance of law firms prioritizing business operations.

Jerry Sto. Tomas walks us through his upbringing and education and how he transitioned from the poultry business to the field of information security. He credits his father for teaching him about leadership and his mother for instilling in him the value of hard work and discipline. Discover how he parlayed his business skills into IT and then cybersecurity.Jerry sheds light on the key cybersecurity risks faced by the healthcare industry. From ransomware to phishing attacks, he shares the key threats that HealthEdge and similar companies face. Learn how he stays up-to-date on the latest threats by leveraging research materials and real-time breach reports, and discover his insights on other types of threats, including web app attacks, corporate espionage, and supply chain attacks. Finally, Jerry explores the implications of generative AI in healthcare organizations, and the policies in place to protect against its misuse. He advocates for a 'no surprises' culture in cybersecurity and stresses the importance of proactively assessing and mitigating risks associated with emerging technologies. Hear his thoughts on the role of patients in safeguarding their data. Support the showHost David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams.

Sergi Luvish, VP of Software Development, HealthEdge joins us to share about his unique journey that led him to where he is today. He is getting ready to start a series of educational bites called Modular Leadership where he will be sharing practical nuggets of executable leadership. Sergi believes in hiring overqualified people for jobs to get better value and apply skills cross functionally. 

For the past few years, digital health has made great strides in providing new ways of healthcare access for patients. But this also means new challenges and obstacles have emerged. This year, at the Digital Healthcare Innovation Summit, leaders in women's health talked about how they and their companies are finding ways to help patients access healthcare more easily, as well as the creation of sustainable business models, understanding the market, and how to measure success. They also share their own experiences of working with patients and what inspired them to find new ways to help the underprivileged. Finally, they address generational needs and differences and discuss their hopes for the future of women's health. Links from this episode:  HealthEdge  

In this episode Stephen Krupa, CEO of HealthEdge Software, to discuss value-based care performance in health plans. Tune in to get a better understanding of technology's role in value-based care automation.This episode is sponsored by HealthEdge.

Every healthcare organization and leader is thinking about how to provide the experiences that patients and consumers have come to expect of the healthcare system. However, the legacy technology platforms that many orgs have today--especially payers--will get in the way of that digital transformation. Sagnik Battacharya, EVP at HealthEdge, talks about how payers can accomplish true business transformation, both in terms of data capabilities and interoperability.

Ryan Mooney is the Executive VP and General Manager of Burgess Source, the payment integrity business unit of HealthEdge. Ryan sheds light on the root causes that lead to waste and errors in the process of providing and paying for healthcare. He points out the need for better data management and clear lines of communication for all participants in the system, including patients, providers, and payers. Ryan says, "I spent 23-plus years working in strict payment integrity. That is a kind of gain share model and contingency where you go, and you identify issues, and you recover them, or you prevent them from happening. The outside vendor keeps a percentage of that recovery and so on. And that way of thinking goes directly to the way that your question was asked, which is, where's the most waste? And I spent over two decades thinking in that same way." "But another way of framing that question is, what is leading to all of these downstream issues? And in the current project with Burgess Source and HealthEdge, we're trying to take payment integrity, this whole world of knowledge, of the ways that things break and where there's waste and where there are broken things, and apply that intelligence to paying things correctly. This means getting down to the root cause and fixing those things so that there is no waste downstream or we're reducing waste downstream." @HealthEdge #PaymentIntegrity #DigitalTransformation healthedge.com Listen to the podcast here

Ryan Mooney is the Executive VP and General Manager of Burgess Source, the payment integrity business unit of HealthEdge. Ryan sheds light on the root causes that lead to waste and errors in the process of providing and paying for healthcare. He points out the need for better data management and clear lines of communication for all participants in the system, including patients, providers, and payers. Ryan says, "I spent 23-plus years working in strict payment integrity. That is a kind of gain share model and contingency where you go, and you identify issues, and you recover them, or you prevent them from happening. The outside vendor keeps a percentage of that recovery and so on. And that way of thinking goes directly to the way that your question was asked, which is, where's the most waste? And I spent over two decades thinking in that same way." "But another way of framing that question is, what is leading to all of these downstream issues? And in the current project with Burgess Source and HealthEdge, we're trying to take payment integrity, this whole world of knowledge, of the ways that things break and where there's waste and where there are broken things, and apply that intelligence to paying things correctly. This means getting down to the root cause and fixing those things so that there is no waste downstream or we're reducing waste downstream." @HealthEdge #PaymentIntegrity #DigitalTransformation healthedge.com Download the transcript here

Health plans have long known the importance of digital transformation. But reorienting large, established organizations around new ways of doing things is not easy, and the COVID-19 pandemic cast a brighter light on existing challenges and introduced new ones. In this episode, we speak to Jake Sattelmair, CEO of Wellframe, and Steve Krupa, CEO of HealthEdge, about how leaders can not only effectively navigate a constantly changing landscape but also spur commitment to change, gain buy-in and implement new ways of working without breaking existing systems.This episode is brought to you by Wellframe. 

Ed is a leadership coach, team coach, strategist, podcast host, and author who helps successful leaders build their self-awareness so they can self-manage more effectively.BLUE CHIP CLIENTSHis clients include Alexion Pharmaceuticals, Biogen, Blue Cross Blue Shield, Bright Horizons, Cabot Risk Strategies, Constant Contact, Dyax Pharmaceuticals, Eaton Vance, edX, Galderma, GMAC, Harvard Pilgrim Health Care, Healthedge, ILPA, Johnson & Johnson, Keurig, Kronos, Lahey Health, Ortholite, Safety Partners, Suffolk, and Vertex Pharmaceuticals. LEADERSHIP PROGRESSIONHe held leadership roles at Iron Mountain, the (former) Federated Department Stores, and the (former) May Department Stores. As a coach and as a human resources executive, I have supported leaders in a variety of high-impact business areas including account management, engineering, finance, human resources, information technology, legal, marketing, product development, product management, operations, and sales.INDUSTRY LEADERSHIPHe also coached international executives in the Program for Leadership Development at Harvard Business School. In my former role as President of the New England Chapter of the International Coach Federation (ICF), I was deeply involved in advancing the coaching profession and serving as a non-profit leader. He is a Professional Certified Coach with the International Coach Federation and a Board Certified Coach with the Center for Credentialing and Education. I am also a volunteer coach for the Coaching for Leadership and Teamwork Program at Babson College.Ed: https://www.linkedin.com/in/edevarts/website: https://www.excellius.comPodcast: http://bebraveatwork.com/

Trevor is the Chief Executive Officer of Baldwin Risk Partners. Trevor joined the Firm in 2009 as a Commercial Risk Advisor working primarily with healthcare and private equity clients, over time he led the firm's Commercial Risk Management Group as Managing Director, followed by being BRP's President & CEO. Trevor has a background investing in and working with companies to shape their goals and success. Before joining Baldwin Risk Partners, Trevor worked at the private equity firm HealthEdge Investment Partners, LLC. While at HealthEdge, Trevor divided his time between working with portfolio companies on operational improvements and assisting in the execution of new transactions. Connect with Trevor Baldwin: https://www.linkedin.com/in/trevor-baldwin-a4053212 This week's episode was supported by Oracle NetSuite (sign up for a personalized product tour at www.netsuite.com/scale) and Indeed (get a $75 credit for your job post at www.indeed.com/scale). --- Support this podcast: https://anchor.fm/uncharted1/support

Key takeaways: Monthly calendar of planned Diversity, Equity, and Inclusion events Getting employee engagement Finding events that work within a remote setting Lessons learned and what has/hasn't worked Meet: Katie Conti is a senior talent acquisition professional with 20 years of experience in resource management and recruiting.  Working with a belief that understanding the business is the key to truly collaborating and partnering, she looks to have Talent Attraction be a strategic part of an organization's success. She is currently focused on building a diverse, robust five-star healthcare IT talent pool at HealthEdge. Katie's passion for building teams and impacting culture with every hire is evident. You can connect with Katie via LinkedIn:  https://www.linkedin.com/in/katie-conti I hope you enjoyed the episode, the best place to connect with me is on Linkedin - https://www.linkedin.com/in/amirbormand (Amir Bormand). Please send me a message if you would like me to cover certain topics with future guests.

What you'll learn: The power of being underestimated Being one of few females as an IT Director in the Massachusetts technology public sector Early exposure to technology had a very positive impact From liberal arts degree to leader in Infrastructure Get ahead by finding the work that nobody wants to do. Doing it. And doing it well. Meet: Kendra Rozett McCormick is Manager of Infrastructure Engineering at HealthEdge, provider of the industry's leading mission-critical claims processing, care management, and payment integrity technology assets for payers. Kendra has a unique background combining a liberal arts education with proven technology leadership, first in the public/local government sector for 11 years, and now in the Healthcare software space, with a passion for leadership and promotion of women in technology. If you have any questions for Kendra, please feel free to reach out via: https://www.linkedin.com/in/kmccormick916/ I hope you enjoyed the episode, the best place to connect with me is on Linkedin - https://www.linkedin.com/in/amirbormand (Amir Bormand). Please send me a message if you would like me to cover certain topics with future guests.

For many healthcare startups and established vendors, partnering with payers is a crucial part of their business plan. And as we know, selling in healthcare is hard. It's even harder when you don't understand how these large corporations work. What do they want? How do they set priorities? How do they make purchasing decisions? How long does that process take? The list goes on, and if you're strategizing without this knowledge you're going to struggle. That's where this episode comes in. Today we're talking with Andrew Adrian-Karlin, Director of Business Platform Product at Highmark Health. Andrew sheds some light on how payers decide what to do and who they decide to do it with. This episode will help you build an effective framework for preparing, approaching, and successfully partnering with payers.   You'll Learn What are “products” from a health insurance point of view? What is the purpose of health insurance? Note: This is the same question we went deep on with Steve Krupa from HealthEdge on Episode 145. Steve's answer is also worth a listen. What are some things that payers are interested in from a “business processing” perspective? How do payers set priorities? What's the typical timeline for bringing on a new vendor and what factors contribute to it? What are the challenges, both internally and externally, that need to be managed when bringing on a new vendor? What can/should vendors do to minimize these challenges and shorten the timeline? How do external factors like the CMS Interoperability Rule or the COVID-19 pandemic impact your priorities? And a little bonus here: Why no one – not payer, not vendor, not lawmaker, and not even the regulator – fully understands new regulations and how that creates an early mover advantage. What are the best ways to keep a pulse on what a health plan is trying to do so that you can partner with them? NOTE: For more tactics on this one, Jeff Byers gave us the journalists take on Episode 62.   Andrew Adrian-Karlin Andrew Adrian-Karlin helps companies do new things by better applying technology. I'm proud to be transforming healthcare at Highmark Health. As the Director of Business Platform- Product at Highmark Health, Andrew focuses on building cross-functional teams and leading Product Managers. He is accelerating speed to market for new products, reducing the cost to market, and delivering improved experiences to Highmark's members. Andrew has more than 10 years of experience in Information Technology. Prior work has included diverse areas like data analytics, cybersecurity, post-merger integration, and system development. He holds a BS in Accounting from Case Western Reserve University, an MBA from Carnegie Mellon University, and a number of professional certificates and certifications. LinkedIn: https://www.linkedin.com/in/andrewadriankarlin/   Highmark Health One of America's leading health insurance organizations and an independent licensee of the Blue Cross Blue Shield Association, Highmark Inc. (the Health Plan) and its affiliated health plans (collectively, the Health Plans) work passionately to create a remarkable health experience for customers. Highmark Inc. and its Blue-branded affiliates proudly cover the insurance needs of 5.6 million members in Pennsylvania, Delaware, and West Virginia. As an industry, health care poses new challenges every day that require deep insights, constant innovation, and new solutions. The Health Plan business has boldly forged ahead with doing things differently, piloting new approaches, and breaking from the pack. Web: https://www.highmarkhealth.org/   Links and Resources Episode 145: How Payers Can Master Core Administrative Transactions and Deliver a World-class Experience to their Members and Providers w/ Steve Krupa Episode 141: The State of Payer Data with Jordan Bazinsky Episode 103: Selling to Health Systems: Advice for Digital Health Startups (Part 1) Episode 105: Selling to Health Systems: Advice for Digital Health Startups (Part 2) Episode 96: The CMS NPRM: Opportunities from the Payer Perspective Episode 85: Lessons on Selling in Healthcare w/ Dom Cappuccilli     The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media. Music by StudioEtar

It may seem cliché to say payers need to be more like Amazon, but the analogy provides fundamental, and surprisingly actionable insights for the health insurance industry. Think about your experience with Amazon (or Google or Zappos, or any other organization that provides a phenomenal customer experience). Whether they're helping you find the right product, or streamlining the purchase, or dealing with a delivery problem, or a return, these organizations have made the transactions feel easy... frictionless... natural.   If you're a payer: Ask yourself, does your front-end member experience, or back-end provider experience even remotely resemble this? If you're a member or provider: Does your experience with health insurance companies even remotely resemble this?   If we're being honest, approximately 100% of you are shaking your heads "No". The reason that Amazon can provide an awesome consumer experience is because, through telemetry and analytics, they know exactly what's happening in their business in real-time. They know how much each decision costs them, and they know it on the spot. That enables automation. And that enables the end-user experience we're trying to emulate. How is this relevant to payers? Well... that's what this interview is all about. Steve Krupa, CEO of Health Edge, explains that the adequacy and data sharing capability of a payer's underlying transaction systems will be the rate-limiting factor when it comes to improving the member and provider experience. And what could that experience look like?   First-pass payment accuracy that reduces the need for "claw-backs", saving health plans money and reducing a key source of provider abrasion Point-of-Service Payments that provide members with transparent out-of-pockets costs and improve provider cashflows. Automatic claims adjudication that works as-well-as, or better than the current workflow, and does it in real-time.   Additionally, Krupa very elegantly explains the transition of health insurance companies from underwriters of risk to managers of risk, and now increasingly, to participants in the delivery of care itself. We're always looking to expand our fundamental understanding of the business of healthcare. This section created some new and powerful connections for me, and I suspect it will for you too.   Steve Krupa, CEO, HealthEdge Software, Inc.  As the leader of HealthEdge, Steve has the unique opportunity to leverage the various aspects of his professional experience. He started out as a Mechanical Engineer and programmer for Johnson Controls, using software and digital interfaces to control large mechanical systems. Later, Steve became involved in the healthcare mergers and acquisitions business, where he worked on over $12BN of strategic acquisitions and recapitalizations, including the landmark acquisition of US Healthcare by Aetna. Prior to HealthEdge, spent 18 years as a healthcare venture capital partner at the Psilos Group. Today, Steve's professional passion is for the people and customers of HealthEdge, and its vision to build its substantial and unique intellectual property into the most innovative solutions partner in the HCIT marketplace. Steve holds an M.B.A. with Distinction from the Wharton School of the University of Pennsylvania, where he graduated a Palmer Scholar; and a B.S. in Mechanical Engineering from the University of South Florida where he was elected to Tau Beta Pi.   About HealthEdge HealthEdge provides modern, disruptive healthcare IT solutions that health insurers use to leverage new business models, improve outcomes, drastically reduce administrative costs, and connect everyone in the healthcare delivery cycle. Its next-generation enterprise solution suite, HealthRules, is built on modern, patented technology and is delivered to customers via the HealthEdge Cloud or onsite deployment. An award-winning company, HealthEdge empowers health insurers to capitalize on the innovations, challenges and opportunities that await in the new healthcare economy. For more information, visit www.healthedge.com. LinkedIn. https://www.linkedin.com/company/healthedge/ Twitter. https://twitter.com/HealthEdge Website. www.healthedge.com   Relevant Links and Resources   Episode #141 The State of Payer Data with Jordan Bazinsky of Cotiviti: Learn about the converging data management challenges that will change the payer industry forever, including clinical data integration and the CMS 2020 Final Rule. Episode 104: Why HIEs Will Lead the Way on Healthcare Quality Measurement w/ John D'Amore Episode 096: The CMS NPRM: Opportunities from the Payer Perspective Episode 094: The Path to Healthcare Interoperability Checkout #HCBiz's extensive coverage of the Provider Directory problem Providence Digital Innovation Group: Publications, research and perspectives on issues that are reshaping health care through digital innovation   The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.

This week on Be Brave @ Work, listen to Laura Tomaino, Vice President, People and Culture at HealthEdge, tells us her thoughts on bravery at the workplace and her story about joining a start-up and some brave conversations she needed to have. Links of interest Laura Tomaino LinkedIn HealthEdge website

Our Host Steve Krupa has a visitor. Aetion CEO Carolyn Magill pops by Steve’s office at HealthEdge to explain how Aetion raised a round of capital it wasn’t seeking. She also delves deeply into how Aetion’s analysis of different types of data – genomic, socioeconomic, EHR’s – can change how healthcare is delivered and how are costs covered.You can WATCH this Breaking Health podcast interview here.

InSecurity Podcast: As a Healthcare CISO, Taylor Lehmann protects more than just Endpoints Is a Patient a User? A Customer? A Client? Wellforce CISO Taylor Lehmann Needs to Protect Them All. Taylor Lehmann is the CISO of a healthcare system spread over 8 locations that treats hundreds of thousands of patients and employs thousands of staff. He has to be on top of all it from a cybersecurity perspective. Wellforce users and “customers” are a very different responsibility for Taylor compared to that of the average CISO. Lives are literally on the line. In this episode of InSecurity, Matt Stephenson chats with Wellforce’s Taylor Lehmann on the role of the CISO at a large, multi-location healthcare system. Taylor isn’t just a suit-and-tie executive, though. He puts on the scrubs and does rounds with the medical staff in order to immerse himself in the daily operations of the facilities. For Taylor, that is the only way to grok what is happening at Wellforce and to know what he and his teams must be doing to protect it About Taylor Lehmann Taylor Lehman (@sidechannelsec) is the CISO of Wellforce and Tufts Medical Center. He was formerly the CPO/CISO/CIO/ Director for Independent Health, HealthEdge, and PwC, as well as the former VP of Cyber Risk Management at State Street Bank. Taylor is also an expert in securing software development and delivery, and is on the boards of Gartner Evanta, the HITRUST Community Extension Program, the TPA Summit, and the Business Associate Council. He has CBCP, CISM, CISA, CRISC, CIPP/US, CCSFP (HITRUST), ITIL, HCISPP, and PMP certifications.  About Matt Stephenson Insecurity Podcast hostMatt Stephenson(@packmatt73) leads the Security Technology team at Cylance, which puts him in front of crowds, cameras, and microphones all over the world. He is the regular host of the InSecurity podcastand host of CylanceTV Twenty years of work with the world’s largest security, storage, and recovery companies has introduced Stephenson to some of the most fascinating people in the industry. He wants to get those stories told so that others can learn from what has come before. Every week on the InSecurity Podcast, Matt interviews leading authorities in the security industry to gain an expert perspective on topics including risk management, security control friction, compliance issues, and building a culture of security. Each episode provides relevant insights for security practitioners and business leaders working to improve their organization’s security posture and bottom line. To hear more, visit: ThreatVector InSecurity Podcasts: https://threatvector.cylance.com/en_us/category/podcasts.html iTunes/Apple Podcasts link: https://itunes.apple.com/us/podcast/insecurity/id1260714697?mt=2 GooglePlay Music link: https://play.google.com/music/listen#/ps/Ipudd6ommmgdsboen7rjd2lvste

Richard Kasperowski interviews Eugene Krylov, VP of Engineering at HealthEdge. Eugene discusses learning, short feedback cycles, and inviting your actual customers to your sprint reviews. Connect with Eugene at https://www.linkedin.com/in/ekrylov, visit HealthEdge at https://www.healthedge.com, and listen to HealthEdge’s CEO’s podcast at https://itunes.apple.com/us/podcast/breaking-health/. To support this podcast, sign up for my newsletter at https://kasperowski.com.

Three years ago, Steve Krupa signed on to host this podcast for Healthegy. Today, things are much different. Now CEO of HealthEdge, a fast-growing healthcare IT company, Krupa discusses the transition and shares his unique VC-CEO perspective. In this podcast he discusses how HealthEdge established the Five Pillars of the company's culture, how he works with his board of directors, and what its plans are for the future.

HealthEdge has built and automated claims processing system for payers, a precursor to the “Digital Payer” that will make insurance and health care easier and cheaper to manage. CEO Rob Gillette joins Breaking Health host Steve Krupa of the Psilos Group in telling how HealthEdge has built a powerful tool for the insurance industry.