Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value Based Care Reimbursement

CMS Medicare Value-Based Care Model Expands to 3 More States

by Vera Gruessner

The states of Alabama, Michigan, and Texas will be able to test the Medicare Advantage Value-Based Insurance Design model beginning on January 1, 2018, according to a fact sheet from the Centers for Medicare & Medicaid Services (CMS). During...

Why Payers Should Consider Consumer Needs in Value-Based Care

by Vera Gruessner

The Healthcare Financial Management Association (HFMA) released a new report called Health Care 2020: Consumerism showing that the health insurance industry has two new trends affecting it: a greater push toward patient cost sharing and outcomes-based...

58% of Payers, Providers Adapt Value-Based Care Reimbursement

by Vera Gruessner

Several surveys from 2016 show that more healthcare providers and payers than ever before are implementing value-based care reimbursement contracts and moving away from traditional fee-for-service payment models. This past June, ORC International...

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 have led to higher rates of preterm births such...

New England, Great Lakes Perform Best at HEDIS Quality Measures

by Vera Gruessner

More than 90 percent of commercial health insurance companies throughout the country adhere to HEDIS quality measures in order to show consumers and surveillance agencies their overall performance with regard to prevention, treatment, and patient...

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...

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 post-acute care providers are finding it difficult...

How Medical Consortium Handles Value-Based Care Reimbursement

by Vera Gruessner

Healthcare organizations around the country have been revamping their strategies to keep revenue stable in the midst of changing healthcare payment models. Reforms have been aimed at helping providers adopt value-based care reimbursement. With...

CMS Accountable Health Communities Model Stresses Social Needs

by Vera Gruessner

This past January, the Centers for Medicare & Medicaid Services (CMS) announced a new funding opportunity for a program called the Accountable Health Communities (AHC) Model, which focuses solely on the social needs of Medicare and Medicaid...

3 Strategies to Follow in Value-Based Care Reimbursement

by Vera Gruessner

In order to have an effective value-based care reimbursement strategy, healthcare payers and providers will need to implement a number of steps in their pursuit of rewarding quality of care instead of quantity as seen in fee-for-service payment...

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 has implemented care coordination measures...

CMS Bundled Payment Models Address Cardiac Care, Hip Surgeries

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) have recently begun implementing additional alternative payment models centered on episodes of care. CMS has proposed new rules for managing the costs of care and coordination among Medicare...

UnitedHealth’s Value-Based Care Reimbursement Improves Outcomes

by Vera Gruessner

Value-based care reimbursement has been hitting both payers and providers as a surefire way to promote payment reform and reduce medical spending. The new models of payment are coming straight from public payers including the Centers for Medicare...

4 Motives Why Hospitals Adopt Provider-Sponsored Health Plans

by Vera Gruessner

Due to the many new transformations taking place within the healthcare industry today such as the transition from fee-for-service reimbursement to value-based care payments, the potential for creating provider-sponsored health plans has grown...

HHS Positions Bundled Payment Models Toward Cardiac Care

by Vera Gruessner

On July 25, the Department of Health & Human Services (HHS) announced further investment in bundled payment models within the healthcare industry. According to a news release from the Centers for Medicare & Medicaid Services (CMS), the...

How to Educate Employers on Value-Based Care Reimbursement

by Vera Gruessner

Value-based care reimbursement is becoming a mainstay of the healthcare industry as hospitals, physician practices, and health insurance companies continue to incorporate alternative payment models. Many payers and providers have pursued bundled...

Key Strategies for Transitioning to Value-Based Care Payments

by Vera Gruessner

With value-based care payments impacting both payers and providers around the country as the healthcare industry transitions toward a new climate based on quality of care, preventive services, and better patient outcomes, health insurers must...

Why Provider-Sponsored Health Plans are Gaining Ground

by Vera Gruessner

There are a number of reasons why provider-sponsored health plans are growing and more hospitals are considering investing in their own health plans instead of partnering with health payers, says Paul Keckley, Ph.D., a healthcare industry expert...

How Accountable Care Organizations Use Preventive Services

by Vera Gruessner

What accomplishments have accountable care organizations (ACOs), providers, and payers reached in their effort to operate value-based reimbursement systems? This is the question that many ACOs are answering today. With value-based care reimbursement...

Why Value-Based Care Reimbursement Needs Risk Adjustment

by Vera Gruessner

The Patient Protection and Affordable Care Act is a very complex piece of legislation that covers a wide range of provider and payer issues. Several not commonly discussed factors include the ACA’s impact on risk adjustment and risk selection....

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