Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value Based Care Reimbursement

Using a Commercial Shared Savings Program to Reduce Care Costs

July 23, 2018 - A commercial shared savings program equipped with the right leadership, clinical insights, and comprehensive care strategies can help payers save significantly on healthcare costs and produce exceptional beneficiary outcomes. In order to achieve these results, Blue Cross Blue Shield of Arizona (BCBSAZ) has developed a shared savings program with ACO Partner, a Change Healthcare...


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Highmark BCBS Saves $260M Using Value-Based Reimbursement

by Thomas Beaton

Highmark BlueCross BlueShield has saved $260 million in avoidable care costs by using value-based reimbursement and provider performance standards to hold healthcare organizations accountable for improving beneficiary...

Cost of Implementing Quality Measures Key for Value-Based Care

by Thomas Beaton

Healthcare payers and providers must develop a better sense of the costs and burdens of implementing quality measures if they are to succeed with value-based care, according to the authors of a recent commentary in JAMA. Leaders from...

Large Employers Aim to DRIVE the Expansion of Value-Based Care

by Thomas Beaton

Large employers are deeply invested in bringing down healthcare spending rates, and have embraced value-based care strategies for ensuring that their employees stay as healthy and productive as possible. As care costs continue to rise...

Guides Help Employers Decide on Accountable Care Organization Use

by Thomas Beaton

The National Business on Health Group (NBHG) has released two comprehensive guides to help employers evaluate the pros and cons of using accountable care organizations (ACOs). Both resources are part of an ACO toolkit to help employers...

Can Value-Based Purchasing Work with Pharmaceutical Companies?

by Thomas Beaton

The Network for Excellence in Health Innovation (NEHI) believes that developing value-based purchasing contracts between payers and pharmaceutical companies will be a critical next step for healthcare reform. Having payer and pharma...

Patient Satisfaction Key for Payer Measurement of ACO Quality

by Thomas Beaton

An article from the American Journal of Managed Care reveals that patient satisfaction within an accountable care organization (ACO) is a strong indicator of the care quality level the organization delivers, giving payers an opportunity to...

State Medicaid Programs Invest in Accountable Care Organizations

by Vera Gruessner

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...

Anthem Cut ER Costs by 3% with Value-Based Care Reimbursement

by Vera Gruessner

  In recent years, the national health payer Anthem has been advancing value-based care reimbursement by collaborating with primary care providers and operating the Enhanced Personal Health Care program, according to a...

Stakeholders Offer Key Principles for Alternative Payment Models

by Vera Gruessner

More than 100 medical organizations sent a letter to President Trump and Vice President Mike Pence on behalf of supporting the healthcare industry’s transition to alternative payment models. The letter outlined the complexities and...

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...

CMS Bundled Payment Models Lead to Greater Patient Selectivity

by Vera Gruessner

What are some of the biggest problems around bundled payment models and value-based care causing difficulties for physicians? According to Corporate Director at Willis-Knighton Health Systems Chris Mangin, the Comprehensive Care for Joint...

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...

Highmark Partners with Aledade’s Accountable Care Organizations

by Vera Gruessner

In December 2016, Aledade Inc., a leader of accountable care organizations (ACOs), and Highmark Blue Cross Blue Shield announced in a company press release a new partnership to provide quality medical treatment through accountable care...

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...

UnitedHealthcare Adopts Bundled Payment Model for Surgeries

by Vera Gruessner

The national health insurance company UnitedHealthcare has followed the lead of the Centers for Medicare & Medicaid Services (CMS) and implemented a bundled payment model specifically for hip, spine and knee surgeries much...

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...

3 Ways Bundled Payment Models Brought Hospital Cost Savings

by Vera Gruessner

Case studies of bundled payment models show significant cost savings among hospitals and both public and private health insurers. The Centers for Medicare & Medicaid Services (CMS), for instance, invested in bundled payment models for...

Humana Advances Population Health Management, Value-Based Care

by Vera Gruessner

The health insurer Humana has been progressing with population health management and value-based care by partnering with the population health company FullWell in December 2016, according to a company press release. The partnership creates...

20% of Surveyed Physicians Familiar with MACRA Regulations

by Vera Gruessner

No more than 20.6 percent of primary care physicians and 19.5 percent of specialists are “very or somewhat familiar” with MACRA regulations, according to a survey completed in 2016 by Merritt Hawkins for The Physicians...

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