Karen Kobelski, MBA

Faced with new government regulations, Medicare Advantage (MA) organizations should be utilizing technology to increase the accuracy of their coding, mitigate their risk, and ensure appropriate care for members.

Developing a terminology strategy that reflects real-world practice and industry standards can help data scientists and other allied data professionals efficiently and accurately identify clinically relevant insights that help improve the health of populations and individual patients.

Research as we know it today, done in isolation and seemingly protected from real-world evidence (RWE), may one day soon be the exception vs the norm, as our ability to amass and extract insights from RWE grows. It’s time that researchers and other industry stakeholders acknowledge the power of using different data sources in a complementary manner to tackle some of health care’s most difficult problems.

By making diligent compliance efforts a priority in the years ahead, health plans can shore up existing processes to achieve financial success and ensure risk adjustment as regulatory bodies take aim at organizational missteps.

Achieving health equity will depend on the quality of huge volumes of health care data and how effectively we can make them accessible and actionable for key stakeholders.

Health insurance companies are anticipating a swell in pent-up demand for delayed or forgone health services in 2020, as well as increased costs associated with distributing COVID-19 vaccines to millions of Americans. To offset the potentially precarious business impact caused by these converging factors, insurers are turning to technology for help.

In preparing for the upcoming implementation of the Interoperability and Patient Access final rule by CMS, best practices for health plans include prioritizing data mapping, sensitivity codes for privacy, and consumer-friendly language in accessible data for patients.

Karen Kobelski is the vice president and general manager of clinical surveillance, compliance & data solutions at Wolters Kluwer. She brings more than 25 years of experience to her position, which expands her previous leadership role over the Safety & Surveillance group to also include the Health Language portfolio of data normalization solutions.

Karen Kobelski is the vice president and general manager of clinical surveillance, compliance & data solutions at Wolters Kluwer. She brings more than 25 years of experience to her position, which expands her previous leadership role over the Safety & Surveillance group to also include the Health Language portfolio of data normalization solutions.