Blog Archives

Payers and Providers Value-Based Care Reimbursement

value based care

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.

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Posted in Population Health, Revenue Cycle Improvement

5 Trends in Business Analytics and Technology that are Improving Healthcare

Wearable tech in healthcare

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.

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Posted in Guest Post

3 Healthcare Trends to Watch for 2017

healthcare trends

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.

Posted in Accountable Care Organizations

Healthcare Transformation Assistance Critical in Changing Times

healthcare transformation

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.

Posted in Uncategorized

Medication Adherence Higher in Patient Centered Medical Homes

medication adherence

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.

Posted in Uncategorized

Key Components to a Great Peer Review Training Program

peer review

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.

Posted in Uncategorized

Accredited IROs Promote a Transparent and Quality Review Process


If you are in the market for an Independent Review Organization (IRO) partner, looking for an IRO that is accredited is a great first step. Accreditation ensures that you receive the highest quality in service and support as well as an IRO who follow strict federal and state regulations. Accredited IROs must comply with important federal and state standards and timelines, ensuring you receive quality support that will help you create efficiencies for your peer review program.

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Posted in Physician Advisor/Peer Review, URAC Accreditation

Telehealth Patients Expected to Hit 7 Million by 2018

telehealth accreditation

Telehealth and telemedicine services are becoming a critical options for patients and providers across the country. While helping close gaps in care and help patients who may not have easy access to services, telehealth will be a important part of healthcare change. It’s estimated that by 2018 there will be 7 million patients who use telemedicine services, more than double the amount in 2013¹.

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Posted in Accreditation

HEDIS Helps Payers Close Gaps in Care

Healthcare IT Pain Points

Editor’s Note: BHM understands the role that data and reporting play in road to quality care and performance. Click here to learn more about how BHM can help you. The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used for

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Posted in Uncategorized

CMS Pilot Program to Compare Network Breadth of Health Plans

health plan network breadth

In April of 2016, CMS announced that a new type of tool to help consumers compare the breadth of plans’ networks on 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.

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Posted in Health Insurance

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