As healthcare payer operations integrate new practices to align with the value-based care paradigm, payers are critically challenged with identifying root causes to solve issues in order to improve and sustain performance. BHM Healthcare Solutions play a critical role in a larger operational system and offers two resources for consideration when reviewing the larger payer operational landscape.
Autism care costs balance in the middle of many competing issues and agendas leaving payers, providers, and consumers trying to sort out the facts from fictions. The size of the funding pie “…over the next 10 years [is] about a half a million youth with autism spectrum disorder (ASD) will enter adulthood. The majority of the costs in the U.S. health care systems for ASD are directed at the adult population: $175 to $196 billion for adults compared to $61 to $66 billion for children.” writes Monica Oss, CEO, Open Minds.
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.
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.
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.
Despite industry uncertainty about the fate of healthcare under the new administration and Republican Congress, health system leaders move ahead and are preparing for the future. A recent Premier Inc. survey show the target areas for improvements within their systems. The results signal growth concerns and why the leaders will not wait for Capitol Hill results.
The largest health plans share more things in common than you might imagine. Striving for the high quality patient care comes to mind. How about striving for process efficiency? Absolutely. Integrating continuous improvements move these organizations ahead of the rest.
Healthcare spending is on the rise. The federal government has begun several initiatives to control costs, increase efficiency, and increase quality. Revisiting one of the ACA, Medical Loss Ratio.
Imaging faster reimbursement cycles must include reviewing processes on both sides of the payer/provider relationship. Too many decades of combative mudslinging makes a comprehensive review and retooling difficult. New organizational structures, like ACOs, begin breaking down barriers allowing for collaborative improvements.
Analyzing your revenue cycle from start to finish can lead to recouping significant revenue dollars for your organization. Knowing what are the most impactful metrics sets revenue cycle experts apart.