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Real Questions
4
Governments

  • Governments: Time to control costs while reducing fraud, waste, and abuse (gaming of system)

  1. Why is your workers comp carrier still have no auto-adjudication process in place?

  2. Why is the plan still reading every clinical note using 20th century manual processes?

  3. Why are you still getting calls from employees why their appropriate care is denied?

  4. Why are you still getting calls from employees that your plan is practicing medicine?

  5. Why are you still allowing use denial of appropriate care as a success metric?

  6. Why is the plan still using metrics of denial of care & not “right-sided” appropriate care?

  7. Why are you still having difficulty instituting reasonable site of service criteria?

  8. Why is the plan still using “AI” that is a one-way conversation (dumb “smart forms”)?

  9. Why is the plan not using real time cognitive feedback for UM? (Israel Patent 251953)?

  10. Why is the plan till talking e-prior authorization that does not contain clinical elements?

  11. Why is the plan not using automated cognitive audit tools for HCC coding for MA plans?

  12. Why is taxpayer money still setting on the plans balance sheet and not on your own?

  13. Why are you still not utilizing PBMs that provide cost transparency as in Florida’s EO?

How did you get here?

Don't Ask...

But you are here... fix it!

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