Health plans create best practices and lead with concrete strategies for preventing opioid overuse. The Association for Community Affiliated Plans (ACAP) recently issued a report detailing the innovations and best practices of its member Health Plans in their efforts to combat opioid misuse and overuse. The opioid epidemic led to an estimated 33,000 deaths and more than 300,000 emergency room visits in 2015, and recognized as a subject of intense debate on Capitol Hill and in statehouses around the country.
Many health plans are facing uncertainties: the changing health insurance landscape, the speed at which value–based care is approaching, and growing demands from customers, to name a few. But one investment may help executives meet each of these challenges—an investment in analytics. Health plans are data rich, yet those data are not always leveraged to understand what happened and why, or predict what is likely to happen. Health plans that don't take advantage of their data may risk being disrupted and left behind. Analytics can be a key payer competitive differentiator setting your organization ahead of the pack.
According to a new report, prominent factors are challenging small hospitals and health systems financial futures and notes organizations can address these obstacles through a transformation leading to a competitive advantage and better health outcomes for patients.
Payers and providers need efficient administrative services for profitability. With all the capital and human resources invested in electronic health records and data exchange security, why are documentation errors still one of the highest cause of adverse determinations? The number of claims slowed by lack of/incomplete/poor EHR documentation became crystal clear in recent reports.
The healthcare industry is undergoing an inevitable shift away from fee for service payment models towards reimbursement models that align with the healthcare triple aim, such as value based payments. The approach and question of which value-based model to implement still remains elusive for many organizations. Let’s take a look at some payment types on the value-based reimbursement spectrum.
Provider-sponsored health plans struggle through the ever-changing political environment. For providers hoping to get a handle on healthcare costs and supplement their own medical data with claims data, launching a health plan has been a strategic move.
The most important strategic security program decision that the organization can make is the framework that the organization adopts for its cyber-security and compliance program.
The era of volatile swings and double-digit growth in employer medical costs appears to be ending. With medical cost trend hovering in the single digits for several years, the industry has been waiting for the inflection point when spending will take off. But that spike appears unlikely to happen. The New Health Economy is settling into a “new normal,” typically characterized by more attenuated fluctuations and a single-digit trend.For four years, medical cost trend has hung between 6 and 7 percent, seeming to settle into a “new normal.” PwC’s Health Research Institute (HRI) anticipates a 6.5 percent growth rate for calendar year 2018, half a percentage point higher than in 2017.
The URAC Report stated Accountable care may still be a relatively new model in some areas, but the numbers of highly successful ACOs are steadily increasing. There were approximately 660 ACOs in the U.S. in 2015. The number increased to 838 last year. Success, however, can be elusive.
Payers and providers connect, both formally and informally, through the reimbursement process. In past times, the relationships were stormy. Today, market forces push the need for better understanding of margin defense and revenue cycle performance. Streamlining internal operations addresses many of these new market demands. For example, patients demand higher value for care pushing more review of claims which push greater need for consistent documentation.