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.
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.
HEDIS is a tool used by 90% of America’s Health Plans to gauge performance on crucial aspects of care and service. By standardizing the way health plans collect, analyze, and report performance information and data, HEDIS creates an equal playing field for all health plans (who use HEDIS) to be compared. The tool is also used by health plans to learn which area they can improve in. On the other end, employers, consultants, and patients use HEDIS data to help them select the best health plan for their needs.
The Centers for Medicare & Medicaid Services (CMS) released Part 2 in a set of data that details information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The CMS believes that The Part D Prescriber PUF data will provide healthcare professionals with important information to drive change within the industry. “These data enable a wide range of analyses on the type of prescription drugs paid for under the Medicare Part D program, and on prescription drug utilization and spending generally.”
In 2014 more than 14,000 people died from prescription opioid overdoses* and the numbers are not decreasing. Prescription Drug Monitoring Programs and the analysis of patient data, are two ways the healthcare industry is fighting the opioid epidemic.
The Centers for Medicare & Medicare Services (CMS) values data. And with the update of their data initiatives, it will now be more transparent and easier to access. Your organization will now be able to benchmark against some of the biggest health systems in the country. Data is crucial for measuring costs, services and trends, especially when it comes to organizational growth.
News of data breaches and cyberattacks have been ruling the headlines since early 2015. In fact, out of the 14 largest healthcare data breaches 5 occurred in 2015. As cyber attacks become more common it’s crucial for healthcare organizations to learn how to protect themselves, and their patient’s data, from breaches and attacks.
The healthcare industry is rapidly growing: With innovations in medical tools and new successful procedures performed annually, there is no shortage of change. Just as vital to the industry are solutions that help manage the information of the millions of patients who visit each year. To keep up with the demand and to facilitate the process, adjusting healthcare information management practices is a necessity. Here are three trends that are being implemented.
Let's talk healthcare trends set into motion by the ACA. The Affordable Act was signed into law March 23, 2010 making 2015 the law’s 5 year anniversary. Can you believe it? Five years later the ACA has sparked change in the healthcare ecosystem and is continuing to churn the wheel of change. But what changes should healthcare organizations expect for the future? PwC Health published a report on post-ACA trends in honor of the law’s 5th anniversary. The report outlines 5 major healthcare trends, Risk Shift, Primary Care, New Entrants, Health Insurance, and States, that it believes the ACA set into motion. We will cover 4 of those trends today!