Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Features

How Payers Can Improve HEDIS Quality Measure Performance

HEDIS quality measures have a significant role in the healthcare industry regarding closing gaps in care and decreasing the use of costly acute care through preventive services. By placing a greater focus on value-based care and quality improvement across healthcare organizations, HEDIS quality measures hold a critical place in helping providers achieve these goals. Health insurance companies...


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Key Steps for Payer Success in Accountable Care Organizations

In recent years, healthcare reforms have set out to reduce constantly rising medical costs, improve coverage for the many Americans who lacked primary care access, and advance population health outcomes. Over the past few years, the accountable...

The Progress and Challenges of the Affordable Care Act

Before the Patient Protection and Affordable Care Act (ACA) became law on March 23, 2010, the healthcare industry faced a number of obstacles particularly in terms of providing medical care and health insurance to many low-income families and...

How Medicare, Medicaid, and CHIP Guide the Health Payer Industry

Medicare, Medicaid, and CHIP, the three major public insurance programs overseen by CMS, often set the tone for the large private health payer industry.  CMS is using all three programs to actively encourage the movement towards value-based...

How Health Insurance Mergers Could Change the Payer Industry

During the summer of 2015, Aetna and Humana, as well as Anthem and Cigna, started a merger process that would reduce four of the nation’s largest insurers down to just two. If the mergers are successful, only three payers would dominate...

How Payers Could Succeed in ACA Health Insurance Exchanges

State and federal health insurance exchanges stemming from the Patient Protection and Affordable Care Act (ACA) offer medical coverage for families and individuals that would have otherwise had little opportunity to obtain a health plan and healthcare...

How Payers Should Prepare for Value-Based Reimbursement

Value-based reimbursement is a new payment strategy between insurers and providers meant to foster higher quality care by incentivizing strong performance with shared savings, bonuses, or other financial rewards. This diverges from the more traditional...

How to Overcome the Challenges of Bundled Payment Models

Bundled payment models are a form of reimbursement between payers and providers that adheres to an episode of care instead of payment for a particular medical service. This reimbursement system was created to transition healthcare providers from...

How the Affordable Care Act Changed the Face of Health Insurance

The Patient Protection and Affordable Care Act (ACA) has revolutionized the health insurance industry in a number of ways. Its impacts have been vast and wide. One of the most significant impacts of the landmark legislation is the upward trajectory...

What Are the Benefits of Accountable Care Organizations?

Accountable care organizations (ACOs) are provider and payer arrangements established to improve care coordination between primary care physicians, hospitals, specialists, and public or private health payers. The Centers for Medicare &...

Time, Commitment Required for ACO, Value-Based Care Success

In healthcare, as in so many other areas of life, patience is a virtue. Providers and payers pursuing ACO development will need to have plenty of it before their care transformation efforts pay off with significant cost savings. As providers...

Exploring Two-Sided Financial Risk in Alternative Payment Models

RevCycleIntelligence As value-based care becomes the name of the game in healthcare, public and private payers are pushing providers to take on more financial accountability for their services through alternative payment models. In a fee-for-service world, providers...

21st Century Cures Act Rekindles Information Blocking Debate

HealthITAnalytics While primarily billed as a much-needed influx of funding for precision medicine, the 21st Century Cures Act is poised to do much more for healthcare than it appears on the surface. In addition to adjusting drug development rules for pharmaceutical...

Balancing Patient Portal Privacy and Access for Pediatric Care

PatientEngagementHIT Patient portals are an important regulatory requirement, with industry professionals touting their ability to better engage the patient and help all participating parties manage patient health. While pediatric and adult patients tend to use the...

State Data Breach Notification Laws Critical to Healthcare Orgs

HealthITSecurity The HIPAA Privacy, Security, and Data Breach Notification Rules require covered entities and business associates to take great care with how PHI is handled, stored, and transferred. Should patient data become compromised, healthcare organizations...

The Benefits and Challenges of Telehealth for Specialists

mHealthIntelligence Telehealth’s potential has always revolved around bringing the doctor to the patient, no matter where each are located. While the concept most often applies to acute or primary care providers, its success is often more visibly demonstrated...

Using Risk Scores, Stratification for Population Health Management

HealthITAnalytics Population health management requires providers to maintain a delicate balance between taking a long view of generalized patient trends and focusing personal attention on the individual and the distinctive circumstances that will influence her...

Why Application Programming Interfaces Are Key for Healthcare

HITInfrastructure Healthcare organizations seeking to create interoperability between internal apps, EHRs, and other data exchange tools, are increasingly turning to application programming interfaces (APIs) to manage the flow of information between disparate...

Top Revenue Cycle Management Vendors and How to Select One

RevCycleIntelligence As value-based reimbursement models, such as the upcoming Quality Payment Program, break down the walls between care quality and healthcare payments, more providers have set their sights on implementing vendor-sponsored revenue cycle management...

What Providers Should Know to Improve Patient Access to Healthcare

PatientEngagementHIT Patient engagement, consumer satisfaction, and patient access to healthcare are three of the most critical pieces of the value-based care puzzle. As outcomes, satisfaction, and patient loyalty become more important to financial security for healthcare...

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