Value-based care reimbursement models (VBR) are becoming a popular choice for many healthcare providers and payers, as fee-for-service, (and traditional incentive based payment models), are phased out. According to a recent McKesson survey “Journey to Value: The State of Value-Based Reimbursement in 2016," 58% of payers and hospitals are planning to adopt value-based care reimbursement models.
There has always been change in the healthcare industry, but the pace of change has recently sped up. Medical practitioners are highly knowledgeable and work hard towards being in line with the latest industry research. However, they can’t possibly keep in mind everything they should for each situation. Even with access to massive amounts of data for the comparison of treatment outcomes, they still need expertise, time to analyze that data, and have it integrated with the medical profile of the patient. Such an in-depth research and statistical analysis goes beyond the scope of a physician. While relying on clinical data and claims data has value, there is a great opportunity for organizations to take their health efforts to the next level by integrating both claims and clinical data. Here are the major technological trends in healthcare right now.
As 2016 comes to a close, now is the time to look at what healthcare trends might bring us into 2017. Current healthcare trends can help healthcare organizations predict changes in the marketplace and isolate places of improvement. From ACOs to behavioral health, here 3 important trends to watch as we enter 2017.
The healthcare industry is rapidly changing and growing. Healthcare reform in one of the biggest factors to jump-starts change in all aspects of a healthcare organization. The rapid shift to value based performance and consumer outcomes, from fee-for-service payment, puts Healthcare Transformation Assistance programs and services in the forefront of change. They are designed to assist your organization in this rapidly evolving environment.
The Patient Centered Medical Home is very important model of care that has been growing in popularity across the national. The PCMH is not specific place but more a model of care focused on accessible, coordinated, comprehensive, and patient centered care. PCMH are also committed to and is committed to quality and safety. The PCMH model is a great way for primary care organizations to put a stronger emphasis on care coordination and communication, which in turn helps transform primary care to be more patient-centered.
Peer Reviews are necessary to remove Conflict of Interest inherent in a healthcare environment by reducing the potential for the organization to make financially driven decisions when applying the Medical Necessity Criteria (MNC) to patient care.
In April of 2016, CMS announced that a new type of tool to help consumers compare the breadth of plans’ networks on HealthCare.gov. A recent update to that announcement (September 2016) has notified the public that the roll out should start in 2017, for a small number of states.
Optimizing your revenue cycle starts with reducing denials. In order to do this, you must have an effective Denial Management strategy in place. According to a new HIMSS Analytics study, 56% of hospitals surveyed said they don’t use a vendor solution for claim denials. However, around 60% of those respondents are planning on purchasing a claims denials management tool within the next year. If you are part of the 40%, now may be the time to think about investing in tools for claims denials.
Health insurance claim denials could be causing your organization to lose a significant amount of revenue each year. An effective Denial Management strategy is one of the fastest ways to recoup lost revenue, and ensure that you are being paid for the care that you are providing. Studies indicate that approximately 25-30% of healthcare claims are rejected or denied. This results in millions of dollars of lost revenue each year. The majority of these losses can be avoided by implementing our unique denial management process.