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Processing Mismanagement: Responding to Change Healthcare’s Meltdown - 4sight Health

April 3, 2024
4sight Health
Summary
In the wake of a significant cybersecurity breach at Change Healthcare, a major claims clearinghouse handling a substantial portion of U.S. medical and drug transaction claims, health policy expert Jeff Goldsmith proposes a transformative shift in how claims are managed and processed. Arguing against the efficiency of a singular, large-scale processor vulnerable to cyberattacks, Goldsmith advocates for the adoption of multiple Administrative Service Providers (ASPs) that would manage claims for both public and private payers, utilizing stringent security measures and standardized procedures. This system aims to enhance cyber-security, streamline claims processing, and pave the way for value-based competition among providers by fundamentally altering the provider-payer dynamic. Goldsmith's proposal also suggests a regional restructuring of healthcare competition, facilitated by impartial regional health authorities utilizing comprehensive performance data to promote informed choice among consumers and employers. This vision for a restructured claims processing landscape seeks not only to mitigate the risks associated with centralized claims handling but also to foster a more efficient, competitive, and value-focused healthcare system.
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