The Centers for Medicare & Medicaid Services released the final version of its hospital quality ratings Wednesday and posted them to the Hospital Compare website. Many of the most well-known hospitals in the nation received below average scores while lesser known facilities took the top scores.
Athena Health recently published the 2016 edition of PayerView, a in-depth review of the biggest payers in their network. Athena Health identifies the shift to value based care and healthcare reform as the biggest challenges to everyone for payers to providers.
The Centers for Medicare & Medicaid Services (CMS) has been pushing value based models that focus on quality of care rather than quantity. This means that most traditional incentive based payment models are being put phased out. The CMS hopes to tie 90% of all Medicare payments to alternative payment methods by 2018. Unlike fee-for-service models, value based models tie quality and cost together. By doing this they can encourage providers to give the best possible care at the best possible cost.
The nation’s addiction to prescription painkillers is hovering at epidemic levels. The CDC reported that in 2014 more than 14,838 people died from overdoses of drugs such as oxycodone. (cite). Providers are now forced to think of new and innovative ways to help stop the epidemic, which is tied closely to the opioid epidemic. Telemedicine has become a huge savior for many rural areas trying to fight drug related deaths and conditions.
The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by 90% of the United States’ Health Plans to measure performance on important elements of care and service. HEDIS standardizes the way health plans collect, analyze, and report data. It creates an equal playing field for all health plans (who use HEDIS) to be compared. It also can be used by employers, consultants, and patients to find the best health plan match for their needs. Many payers are now using value based reimbursement models to help meet HEDIS benchmarks. These value based programs make providers accountable for closing gaps in care and meeting HEDIS measures.
Behavioral Health Integration has become one of the largest trends in healthcare this year. With one in 5 adults¹ experiencing a mental health condition each year, mental health can longer be pushed to the back burner. The demand for behavioral health services across the nation is sky rocketing, putting BH integration in an important position to help close gaps in care. It will take everyone from provider to payers breaking the stigma surrounding mental health and investing in ways to improve access to care and care outcomes.
On September 22, 2016 the NCQA announced the release of the 2016-2017 Health Insurance Plan Ratings, this is the second year of the NCQA's new rating methodology. The Health Insurance Plan Ratings. which are published annually and compare the quality and services of more than 1,000 health plans across the United States. One new aspect of the 2016-2017 ratings is that WebMD will be publishing the ratings on their WebMD.com.
The shift to accountable care and value based payment models is coming. Accountable Care Organizations (ACOs) are just one of the value-based models making waves throughout the healthcare industry. Based on current growth trends it is predicted by 2020 approximately 70 million people will be covered by ACOs. Focusing on shared accountability and quality improvement, ACOs have become champions of the healthcare triple aim. Not to mention a major player in CMS’ plan to tie a large percentage of payments to value by 2017. As ACOs soar in popularity now is the time to weigh your options. Are you are thinking or making the transition to an ACO? What are the benefits
Thanks to The Excellence in Mental Health Act (ExACT) passed in 2014, it’s predicted that 2016 will be a big year for Behavioral Health. As the country takes critical steps towards moving Behavioral healthcare off the back burner, demand for these services continues to grow. This will result in ample opportunity for organizations diving into Behavioral Health or BH Integration to champion the cause in 2016. But it’s important to remember that the impact of Behavioral health moves across the care continuum.
Choosing the right Peer Review Program can be difficult. It’s important to look for a Peer Review Program that distinguishes itself through quality work, ongoing training, full compliance, and the latest technology. You want to trust the organization you choose and make sure they are industry certified. Use these 5 tips to help you choose a Peer Review Program or use as a guide for your current vendor.