Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value Based Care Reimbursement

Why HEDIS Quality Measures Matter for Value-Based Care

by Vera Gruessner

The Healthcare Effectiveness Data and Information Set (HEDIS) is used by more than 90 percent of health payers to assess and collect data on the performance of providers. HEDIS consists of a number of different measures on which healthcare providers...

How Quality Metrics Affect Value-Based Care Reimbursement

by Vera Gruessner

In today’s changing healthcare landscape, public and private health payers are attempting to investigate new payment models in order to reduce the continually rising medical spending. Whether it’s bundled payments or accountable care...

High-Deductible Health Plans Dominate Employer Offerings

by Vera Gruessner

Today, the consumer or employee is left with much higher out-of-pocket costs than in previous years. Within the Kaiser Family Foundation’s 2015 Employer Health Benefits Survey, statistics show that the number of workers with a standard...

Payers Seek Cost, Integration Efficiencies for Value-Based Care

by Anand Natampalli, MBA

Health insurance is no longer primarily a business-to-business transaction between payer organizations and employers. Today, payers must be prepared to holistically meet the needs of millions of individual consumers—from onboarding and...

The Role Risk Plays in Value-Based Care Reimbursement Models

by Vera Gruessner

The expansion of value-based care reimbursement is making headway across US hospitals and clinics. To better prepare for the transition to value-based care reimbursement, IDC Health Insights, a healthcare IT consulting company, offers advice...

29% of Doctors Have Tools Needed for Value-Based Care Payments

by Vera Gruessner

While value-based care payments are making headway across the country, there are still barriers that stand in the way of payers and providers fully embracing these alternative payment models. A report from Quest Diagnostics and Inovalon found...

Value-Based Care Payments May Reach 60% in Next Five Years

by Vera Gruessner

Value-based care payments are quickly becoming a mainstay in today’s health insurance industry with more payers jumping on the bandwagon of bundles, alternative payment models, and accountable care organizations. A report commissioned by...

Why Maternity Care Needs Episode-Based Bundled Payments

by Vera Gruessner

Episode-based bundled payments are becoming a sought-after reimbursement model throughout the healthcare industry. Along with the Centers for Medicare & Medicaid Services and its focus on implementing bundled payments, private payers are...

Why Cigna Succeeds in Value-Based Care Reimbursement Model

by Vera Gruessner

Earlier this month, the mobile technology company athenahealth released its annual PayerView Report, which delves into the complex and evolving relationship between payers and providers, according to a company press release. This report offers...

Service-Based Organization Strengthens Population Health

by Vera Gruessner

Blue Cross Blue Shield of Arizona (BCBSAZ) has recently partnered with McKesson Business Performance Services to form a service-based organization called ACO Partner meant to function in the evolving value-based care reimbursement environment...

Audits against Medicare Advantage Organizations Found Subpar

by Vera Gruessner

In order to ensure government funding isn’t used to pay erroneous or fraudulent medical claims, the Centers for Medicare & Medicaid Services (CMS) conducts risk adjustment data validation (RADV) audits among Medicare Advantage organizations....

Do Medicare Part B Prescription Drug Changes Hurt Rural Hospitals?

by Vera Gruessner

The proposed changes to the Medicare Part B prescription drug program is finding opposition among multiple medical organizations. The Centers for Medicare & Medicaid Services (CMS) will need to address the problems in the new proposed rule...

How to Prevent Healthcare Underuse in Bundled Payment Models

by Vera Gruessner

Value-based care reimbursement including bundled payment models or accountable care organizations may help medical providers and payers achieve the Triple Aim of Healthcare which is better patient care, stronger population health outcomes, and...

Accountable Care Organizations Keep Growing Across US

by Vera Gruessner

The Patient Protection and Affordable Care Act led to the  development of the Medicare and Medicaid Innovation Center, which eventually brought the creation of accountable care organizations and the Medicare Shared Savings Program....

SNF Medicare Reimbursement Expected to Rise by $800 Million

by Vera Gruessner

Last week, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that changes the Medicare reimbursement policies at skilled nursing facilities for 2017. Essentially, the proposed rule further brings Medicare payments...

Medicare Must Remain Cautious with Alternative Payment Models

by Vera Gruessner

The federal government has brought a tremendous amount of focus on reforming provider-payer reimbursement in order to reduce the rising healthcare expenditure around the country. New regulations have been implemented to improve medical care as...


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