Codoxo, a trusted provider of healthcare artificial intelligence solutions for healthcare payers, agencies and pharmacy benefits managers (PBMs), today announces its “Trends & Predictions for Healthcare Cost Containment in 2023.” Compiled by Codoxo leaders and domain experts, this second annual roundup of industry trends for fraud, waste and abuse (FWA) and payment integrity highlights factors affecting FWA growth, measures being adopted by healthcare organizations to battle it, and reforms taking shape in healthcare payments, among other trends.
“Fraud, waste and abuse in the healthcare system adds up to hundreds of billions of dollars each year. Unfortunately, these costs are often passed along to members via higher insurance premiums and reduced quality of care,” explains Musheer Ahmed, Ph.D, Codoxo CEO and Founder. “Fortunately, advancements in AI and machine learning are helping healthcare companies anticipate and detect fraud and avoid inaccurate payments faster, fueling a more efficient and effective healthcare system. As innovators tracking market forces, we’re uniquely poised to guide healthcare leaders as they develop their strategic imperatives for the coming year.”
Codoxo’s report takes an in-depth look at five key trends:
- Consumerization of Healthcare Leads to Payment Reforms: Consumers are seeking easier, faster and better payment experiences. The significant increase in patients opting for digital payments highlights the need to catch fraud sooner in the payment cycle. With 89% of Americans using digital payment tools, healthcare companies are being forced to adapt and respond, including revamping outdated billing methods and siloed data systems.
- Healthcare Price Volatility Continues – But Relief is on the Horizon: Global healthcare spending is on the rise, and U.S. healthcare spending is expected to reach 19.7% of GDP by 2028. Pressure is on for providers to keep costs down while maintaining quality of patient care. As a result, more healthcare organizations are embracing a “shift left” approach to work with providers on improving their coding and billing practices by identifying discrepancies and erroneous claims much earlier in the healthcare payment lifecycle, rather than rely on the “pay and chase” approach of trying to recover money later.
- Heavy AI Adoption Creates Big Wins in Healthcare Fraud Fight: Healthcare organizations have become keenly aware of the urgent need for AI and predictive analytics that can detect fraudulent schemes such as excessive upcoding, unbundling of services, and other COVID-19 bypasses. As a result, they are proactively seeking innovative FWA and payment integrity solutions that can build connections across all data points and detect problems earlier and with greater accuracy.
- Key Changes in Healthcare Will Be Data-Driven: The healthcare industry continues to move to a more digitized system, which will result in increased savings, streamlined payments, and accelerated ROI. The shift creates challenges and opportunities for healthcare companies to adopt solutions that address data silos, cull data from a multitude of sources, and increase information accuracy and transparency.
- Healthcare Cloud Adoption Requires Systemic Changes in Cybersecurity Standards: Bad actors have become more opportunistic during healthcare’s digital transformation, forcing organizations to adapt to a new set of standards such as HITRUST CSF. This movement is driving greater cybersecurity awareness, training, data protection, and even cloud migration.
For more information about Codoxo’s “Trends & Predictions for Healthcare Cost Containment in 2023,” please visit our blog.
With a mission to make healthcare more affordable and effective for everyone, Codoxo is the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. The Codoxo Unified Cost Containment Platform helps clients manage costs across network management, clinical care, provider coding and billing, payment integrity, and special investigation units. Our software-as-a service applications are built on our proven Forensic AI Engine, which uses patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques. Our solutions are HIPAA-compliant and operate in a HITRUST-certified environment. For additional information, visit www.codoxo.com.