Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Accountable Care Organizations

CMS Accountable Care Organization Model Targets Dual Eligibles

by Vera Gruessner

On December 15, the Department of Health & Human Services (HHS) announced the creation of the new Medicare-Medicaid Accountable Care Organization (ACO) Model. The model is meant to improve the quality of care and decrease costs of beneficiaries...

Top 10 Healthcare Insurance Headlines from 2016 Involve Value

by Vera Gruessner

Over the last year, the medical insurance industry has undergone a variety of changes and overcame challenges as the space transitioned to value-based care. Below we outline ten of the most influential healthcare insurance headlines from 2016...

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...

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 higher spend, members regularly show poor health...

Premier Offers Healthcare Policy Improvements for ACOs, Payers

by Vera Gruessner

Earlier this year, the provider alliance organization Premier Inc. announced in a company press release a number of recommendations meant to improve the framework of healthcare policy. The key points meant to improve the creation of healthcare...

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 trends throughout the insurance industry...

Population Health Helps Medicare ACO Models Earn Shared Savings

by Vera Gruessner

Medicare ACO models operating through the Medicare Shared Savings Program have faced some significant challenges in garnering shared savings and taking on more financial risk. With multiple programs competing for funding from the Centers for...

CMS Cuts Wasteful Medical Spending, FFS Improper Payments

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) has reduced the Medicare fee-for-service improper payment rate from last year’s 12.1 percent to 11 percent in 2016, The CMS Blog reports. CMS has dedicated itself in recent years to...

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 higher than in recent years. For instance,...

Premier Accountable Care Organizations Improved Quality in 2015

by Vera Gruessner

New results from the Premier Inc. Population Health Management Collaborative (PHMC) show that accountable care organizations (ACOs) within the collaborative improved quality and cost reduction in 2015 better than other ACOs operating through...

Care Coordination Vital in Accountable Care Organizations

by Vera Gruessner

Healthcare payers looking to transition to new payment systems and better coordinate care across multiple facilities would benefit from working within accountable care organizations (ACOs). Within ACOs, payment is linked to quality performance...

How MACRA Requirements Impact Accountable Care Organizations

by Vera Gruessner

MACRA legislation impacts a number of healthcare providers and entities including accountable care organizations (ACOs). Only a few Medicare accountable care organizations will actually be able to participate in Advanced Alternative Payment Models...

Vermont’s All-Payer Model Limits Medical Spending Growth

by Vera Gruessner

Vermont has been working on regulatory actions that would reform healthcare payment throughout the state specifically through an all-payer model. Last week, the Centers for Medicare & Medicaid Services (CMS) announced in a press release the...

Accountable Care Organizations Expand Use of Social Services

by Vera Gruessner

Today, accountable care organizations (ACOs) are focused on expanding their coordination efforts with social service agencies and community resources, according to findings from a report completed by the Premier Research Institute and the Robert...

ACO Investment Model May Improve Care Delivery in Rural Areas

by Vera Gruessner

While healthcare reform and legislation like the Affordable Care Act have brought medical coverage to an additional 20 million Americans across the country, the patient community still faces some challenges especially in rural areas. When comparing...

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 bundled payment models, according to a comment...

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 various value-based CMS programs such as accountable...

VT All-Payer Model Aligns Costs for Public, Private Insurers

by Vera Gruessner

The state of Vermont is moving forward with establishing an all-payer model that uses accountable care organizations and ensures a provider is reimbursed by an equal amount among all healthcare payers for a particular service. The Vermont government...

Is Primary Care the Solution to Value-Based Care Challenges?

by Vera Gruessner

Transitioning to value-based care reimbursement and managing accountable care organizations (ACOs) comes fraught with specific challenges. Both reports from healthcare organizations and interviews with experts who’ve implemented ACOs tend...

How Accountable Care Organizations Meet Quality Benchmarks

by Vera Gruessner

Accountable care organizations (ACOs) are relatively new patient care models that can operate with either public or private health payers. Initially, the Centers for Medicare & Medicaid Services (CMS) created the first accountable care organizations...

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