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In 2023, HCA Healthcare, which operates 182 hospitals and thousands of health care facilities across 20 states, experienced the third-largest health data breach overall and the largest of the year ...
These databases enable research on health and policy issues at the national, State, and local levels, including cost and quality of health services, medical practice patterns, access to healthcare, and outcomes of treatments. AHRQ has also developed a set of software tools to be used when evaluating hospital data.
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
The relationship between health care provider and insurance company is that of a vendor to a subcontractor: health care providers are contracted with insurance companies to provide health care services. The interaction begins with the office visit: a physician or their staff will typically create or update the patient's medical record.
[1] [2] The NHCX aims to standardize and simplify the exchange of health claims, making it easier for insurance companies, government schemes, and healthcare providers like hospitals and labs to share data, documents, and images. This system will also make claims processing more transparent and efficient, lowering operational costs. [3] [4]
Real world data (RWD) in medicine is data derived from a number of sources that are associated with outcomes in a heterogeneous patient population in real-world settings, including but not limited to electronic health records, health insurance claims and patient surveys.
In addition to medical expense insurance, "health insurance" may also refer to insurance covering disability or long-term nursing or custodial care needs. Different health insurance provides different levels of financial protection and the scope of coverage can vary widely, with more than 40% of insured individuals reporting that their plans do ...
For example, for diabetes, HEDIS selects an eligible population based on age (18–75 years), continuous enrollment with a certain health insurer and certain "Events/diagnosis" from pharmacy data (electronic), insurance claims data (electronic) or from medical records. Pharmacy data is based on a list of medications prescribed for diabetes.