Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Best Practices

State Medicaid Programs Invest in Accountable Care Organizations

February 2, 2017 - Last month, the Center for Health Care Strategies released a fact sheet outlining the growth of state Medicaid programs operating accountable care organizations (ACOs). Right now, there are 10 states that are managing Medicaid ACO programs while an additional 11 states are looking to create Medicaid programs to advance accountable care organizations. In order to improve care coordination...

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Top 4 Ways Payers Could Improve Patient Health Outcomes

by Vera Gruessner

Health insurance companies have been putting more focus on preventive care, a reduction in unnecessary medical testing, and better patient health outcomes by transitioning to value-based care reimbursement. National payers have utilized a number...

How to Develop HEDIS Quality Measures for Pediatric Care

by Vera Gruessner

The American Academy of Pediatrics (AAP) announced yesterday on its website that it will be partnering with the National Quality Forum (NQF) to connect quality metrics to the interests of children and pediatric care. The National Quality Forum...

Are Bundled Payment Models or Capitation the Better Choice?

by Vera Gruessner

  Today, healthcare payers have multiple ways to reimburse providers for performing medical services that move away from the traditional and more costly fee-for-service reimbursement system. Two such possibilities include capitation payment...

Should Accountable Care Organizations Include Social Services?

by Vera Gruessner

While government agencies, healthcare payers, and medical organizations put their efforts and hopes in advancing accountable care organizations (ACOs), these healthcare delivery reforms lack significant social service interventions, according...

Vermont Blue Cross Plan Reaches Highest Member Satisfaction

by Vera Gruessner

Blue Cross and Blue Shield of Vermont (BCBSVT) announced in a company press release this month that the payer has achieved the highest scores for member satisfaction and efficiency rankings for the fourth continuous year. This particular Blue...

Key Best Practices for Success on the Health Insurance Exchanges

by Vera Gruessner

Which healthcare insurers are succeeding in the health insurance exchanges? What best practices can be taken from these payers? The weekly newsletter Washington Health Policy Week in Review published an editorial answering these questions by...

How Payers Could Assist Primary Care Docs with Value-Based Care

by Vera Gruessner

How can health insurance companies improve their relationship with primary care practices? How can payers work with primary care providers to expand value-based care reimbursement?  For answers to these questions,

84% of Physicians Unsure of Quality Payment Program Conditions

by Vera Gruessner

As many as 84 percent of polled independent physicians and medical staff are unaware of how to meet the requirements of MACRA’s Quality Payment Program, according to a survey from Kareo. The majority of surveyed physicians, however,...

Key Challenges and Solutions of Healthcare Payment Reform

by Vera Gruessner

Healthcare payment reform is becoming more common across payers and providers with many stakeholders transitioning from the traditional fee-for-service reimbursement system to value-based care payments. Representatives from the National Academy...

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...


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