Bundled Payments

Tom Price and His Stance on Value-Based Care Reimbursement

by Vera Gruessner

Representative Tom Price, an orthopedic surgeon, was nominated to be the next Secretary of the Department of Health & Human Services (HHS) on November 29. What does this nomination mean for...

UnitedHealth Adopts Bundled Payment Model for Orthopedic Care

by Vera Gruessner

Healthcare payers are finding that their reimbursement totals show higher spend for hip, knee, and spine surgeries and other orthopedic care when compared to other forms of treatment. Along with the...

Top 3 Trends Affecting the Health Insurance Market in 2016

by Vera Gruessner

Looking back at 2016, there were a number of different trends that continued to impact the health insurance market. The Triple Aim of Healthcare continues to be a major part of the ongoing reforms and...

UnitedHealth Group Adopts Bundled Payment Models for Surgeries

by Vera Gruessner

The commercial payer UnitedHealth Group has begun expanding its involvement in bundled payment models. Forbes reported that UnitedHealth will be implementing bundled payment models for spinal surgeries...

Humana Serves 63% of Members through Value-Based Care Payment

by Vera Gruessner

The future for the health insurance industry likely revolves around value-based care payment, which has grown in use steadily over the last several years. Recent healthcare reforms have centered around...

Deductibles, Out-of-Pocket Healthcare Spending Rose 3% in 2015

by Vera Gruessner

Healthcare spending within the private health insurance market has grown 4.6 percent in 2015, according to a press release from the Health Care Cost Institute (HCCI). This type of growth in spending is...

How to Favorably Manage Risk in Value-Based Care Reimbursement

by Vera Gruessner

While downside risk does not incentivize providers to take part in value-based care reimbursement policies, data-driven technology and a combination of financial motivations may encourage physicians to...

Why Reviewing Pricing Trends is Key for Bundled Payment Models

by Vera Gruessner

When payers begin to adopt bundled payment models, they may find some challenges standing in their way to truly succeed within these alternative payment solutions. For example, when attempting to...

Commercial Payers Behind CMS in Bundled Payment Models

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) have heavily invested in pursuing bundled payment models as an alternative form of payment for medical care among Medicare beneficiaries....

Why Accountable Care Organizations Should Adopt Bundled Payment

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) should consider allowing Track 1, 2, and 3 accountable care organizations (ACOs) to participate in cardiac and comprehensive joint replacement...

Private Payers Follow CMS Lead, Adopt Value-Based Care Payment

by Vera Gruessner

Commercial payers are following the lead of the Centers for Medicare & Medicaid Services (CMS) when it comes to adopting value-based care payment protocols. More private payers have implemented...

Latest CMS Bundled Payment Strategies May Need Revision

by Vera Gruessner

The Health Care Incentives Improvement Institute has found problems with some of the latest bundled payment strategies coming from the Centers for Medicare & Medicaid Services (CMS) including flaws...

How Payers Could Meet Employer Needs in Bundled Payment Models

by Vera Gruessner

While the number of bundled payment models adopted by hospitals and payers is growing, implementation of value-based care is an innovative and modern idea that many healthcare providers are still...

3 Key Steps for Payers to Succeed in Value-Based Care Payment

by Vera Gruessner

Commercial health insurance companies have little reason to remain attached to fee-for-service payment systems since the rate of healthcare costs continues growing and the healthcare industry as a...

4 Ways Health Payers Could Decrease Medical Spending Growth

by Vera Gruessner

Health insurance companies are often looking for key methods and best practices to reduce rising healthcare costs. Payers could avoid the continual increase in medical spending by reducing the rates of...

How Maternity Care Home Model Reduces Premature Birth Rate

by Vera Gruessner

The healthcare industry has often found it problematic and costly to manage the health of newborns and mothers of preterm births. There have been social problems among pregnant women that...

CMS Bundled Payment Models Cut $864 for Orthopedic Care Episode

by Vera Gruessner

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a report encompassing the second annual evaluation of the Bundled Payments for Care Improvement initiative, according to The...

Healthcare Bundled Payments Hinder Skilled Nursing Facilities

by Vera Gruessner

How are skilled nursing facilities and other post-acute care centers handling the transition to a value-based care reimbursement environment? Fitch Ratings stated in a press release that many...

URAC Stresses Accreditation in Medicare Physician Fee Schedule

by Vera Gruessner

This past July, the Centers for Medicare & Medicaid Services (CMS) released revisions to the Medicare Physician Fee Schedule for next year and placed the proposed rule on the Federal Register for...

Empire BlueCross BlueShield Rewards Strong Care Coordination

by Vera Gruessner

Healthcare payers are often looking for ways to improve care coordination in an effort to enhance patient outcomes and reduce medical spending. Empire BlueCross BlueShield is one healthcare payer that...