Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Best Practices

Value-Based Care Drives Progress in Population Health Management

January 18, 2017 - Population health management is becoming a more prominent topic of interest among healthcare payers as they strive to transition to value-based care reimbursement and improve patient outcomes. A report from the Institute for Health Technology Transformation sponsored by IBM Watson outlined how many healthcare systems are investing in population health management by partnering with accountable...


More Articles

Value-Based Care Drives Progress in Population Health Management

by Vera Gruessner

Population health management is becoming a more prominent topic of interest among healthcare payers as they strive to transition to value-based care reimbursement and improve patient outcomes. A report from the Institute for Health Technology...

Why Payers Should Reduce Cost Sharing for High-Value Care

by Vera Gruessner

Today, more healthcare payers are positioning greater cost-sharing onto the consumers to keep from raising premium rates, according to commentary published in JAMA Internal Medicine. The 2016 National Health Insurance Survey discovered that 40...

Prospective vs. Retrospective Healthcare Bundled Payment Models

by Vera Gruessner

When implementing healthcare bundled payment models, providers and payers have two main strategies to choose from: prospective or retrospective bundles. A prospective healthcare bundled payment model involves creating a budget when the episode...

5 Best Practices to Advance Value-Based Care Reimbursement

by Vera Gruessner

When payers begin to transition to value-based care reimbursement from the more traditional fee-for-service payment system, company executives and financial experts may find it takes longer than expected to adopt the new payment structures while...

Key Steps for Payers to Improve Population Health Management

by Vera Gruessner

In recent years, population health management has become a larger factor in the success of a health insurance company. With more payers transitioning to value-based care reimbursement platforms, the quality of care and patient outcomes have grown...

Medical Organizations Advise Changes for Quality Payment Program

by Vera Gruessner

The healthcare provider community has shown some concern about MACRA implementation and the quality payment program. The Advisory Board released a survey last month showing that 70 percent of 30 medical groups were concerned about MACRA regulations...

Accountable Care Organizations May Improve Diabetes Management

by Vera Gruessner

Diabetes is a major public health concern for the medical industry with 29.1 million Americans or 9.3 percent of the population diagnosed with the disease in 2012, according to the American Journal of Managed Care (AJMC). In fact, the American...

How Payers, Providers Could Streamline Medical Claims Management

by Vera Gruessner

Successful medical claims management and processing is not always easy to garner for health insurance companies due to a lack of training among insurance agents, missing or inaccurate documentation, and the general time-consuming aspect...

Blue Cross Health Plans Expand Value-Based Care Reimbursement

by Vera Gruessner

Along with other national payers, Blue Cross Blue Shield health plans have been investing in expanding value-based care reimbursement. For example, New York-based Excellus Blue Cross Blue Shield has partnered with vendors to use analytics and...

5 Solutions for Conquering Challenges of Bundled Payment Models

by Vera Gruessner

Despite strong optimism and stakeholder enthusiasm, a new bundled payment program operated by the Integrated Healthcare Association and the RAND Corporation faced major problems and delays. A report from the Agency for Healthcare Research and...

4 Major Ways to Succeed in Value-Based Care Payment Strategies

by Vera Gruessner

What areas should payers and providers focus on when contracting through a value-based care payment strategy? In order to succeed in value-based care payment models, insurers and practitioners may need to focus on population health management,...

4 Key Ways Payers Could Reach HEDIS Score Thresholds

by Vera Gruessner

Health payers looking to increase consumer satisfaction and member retention may need to reach care quality metrics and HEDIS measures. The National Committee for Quality Assurance (NCQA) is responsible for many aspects of HEDIS measures and...

Population Health Management Helps ACOs Earn Shared Savings

by Vera Gruessner

Continually rising medical costs without significant benefits to patient care have led both public and private payers to invest in value-based care payment structures such as accountable care organizations (ACOs). However, when payers and providers...

How Healthcare Payers Could Reduce Wasteful Spending

by Vera Gruessner

For many years, the health insurance industry has been working to address wasteful spending among hospitals and medical practices. Some of the areas of wasteful spending relate to duplicative medical testing, unnecessary diagnostics, and excessive...

Humana Standardizes Healthcare Quality Measures for Physicians

by Vera Gruessner

Last week, Humana announced in a company press release the development of a Clinical Quality Metrics Alignment (CQMA) program meant to simplify and regulate healthcare quality measures. The new strategy will be used specifically among doctors...

Top Ways Payers Integrate Patient Engagement Strategies

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) announced last week the creation of the CMS Person and Family Engagement Strategy, The CMS Blog states. This CMS initiative is meant to stimulate patient engagement and bring the patients...

4 Ways Payers Could Improve Healthcare Price Transparency

by Vera Gruessner

Healthcare price transparency remains a key issue for health payers across the country. In order to strengthen member retention efforts especially during open enrollment periods, payers will need to boost price transparency to improve consumer...

Key Ways Payers Could Improve Medical Claims Management

by Vera Gruessner

Medical claims management is a key aspect of the payer-provider relationship. However, medical claims management tends to include multiple challenges for both payers and providers. Some of the problems stem from a lack of training in medical...

UnitedHealthcare Cut Costs through Value-Based Care Programs

by Vera Gruessner

Last month, UnitedHealthcare released a report outlining the benefits of value-based care programs. The report called Collaborative and Coordinated: How Value-Based Care Programs are Driving Improvements in Quality and People’s Health began...

Patient Engagement Helps Payers on Affordable Care Act Exchanges

by Vera Gruessner

Many health insurance companies selling health plans through the Affordable Care Act exchanges have been seeing higher and higher rates of financial losses. Some payers such as Aetna, Humana, and UnitedHealth Group have even pulled back from...

X

Sign up for our free newsletter:

Our privacy policy

no, thanks