Medical Loss Ratio: Updates and Impact

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.

Most Bang: Impactful Metrics For RCM

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.

Value-Based Payment Models and the Future of Healthcare

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.

By | 2017-04-02T13:28:01+00:00 October 11th, 2016|Financial, Health Care Reform, Uncategorized|0 Comments

More Competition? Specialty Pharmacy Growth

The specialty pharmacy industry is booming and as many pharmacies opt for moving down the specialty pharmacy accreditation path, many hospitals and healthcare systems are starting to realize opening their own specialty pharmacies (or partnership with one) could be a good idea. The jump to specialty pharmacy for a health system or hospital, isn’t only a revenue driver as it gives them access but could also help with re-admissions, quality of care, and data collection. And as specialty pharmacies crop up all over the country, with an estimated 250 to be accredited by the end of 2015, it is the perfect opportunity for health systems to take fate into their own hands. From driving revenue, to increasing quality of care here are three main areas a hospital or health system can benefit in an in-house specialty pharmacy.

Understanding Value Based Reimbursement

The healthcare industry has undergone major changes since the rollout of the Affordable Care Act and now a new type of reimbursement model is putting traditional incentive based payment models on the shelf for good. Value based reimbursement, which ensures that providers are rewarded for performance, quality, and cost reduction (instead of number of services provided), is a model that will help shape the future of healthcare.

Centers for Medicare & Medicaid Services Testing New Payment Models for Drugs

The Centers for Medicare & Medicaid Services is testing some new reimbursement and payment models for drugs, some of which mirror models currently used in the private sector. Medicare hopes working with providers, like many private payer networks, will lead to more efficiencies in prescriptions and eventually to lower costs.

By | 2017-04-02T13:28:07+00:00 April 27th, 2016|Financial, Medicare and Medicaid, Webinar|0 Comments

California Insurance Marketplace Imposes New Quality, Cost Conditions On Plans

Moving into a realm usually reserved for health care regulators, the California health marketplace Thursday unveiled sweeping reforms to its contracts with insurers, seeking to improve the quality of care, curb its cost and increase transparency for consumers. The attempt to impose quality and cost standards on health plans and doctors and hospitals appears to be the first by any Obamacare exchange in the nation. Among the biggest changes: Health plans will be required to dock hospitals at least 6 percent of their payments if they do not meet certain quality standards, or give them bonuses of an equal amount if they exceed the standards.

By | 2017-04-02T13:28:07+00:00 April 8th, 2016|Financial, Health Insurance, Health Insurance Exchange, Quality Improvement Programs|Comments Off on California Insurance Marketplace Imposes New Quality, Cost Conditions On Plans

5 Healthcare Industry Issues of 2016: Part 1

5 Healthcare Industry Issues for 2016

It’s only the beginning of 2016 but here at BHM Healthcare Solutions we have been keeping […]

By | 2017-04-02T13:28:07+00:00 January 22nd, 2016|Financial, Healthcare IT, Strategic Planning, Telehealth and Telemedicine|Comments Off on 5 Healthcare Industry Issues of 2016: Part 1

Rural Hospitals Face Financial Pressure

Rural Hospitals Face Financial Pressure

Rural Hospitals Face Financial Pressure according to a recent article

MOUNT VERNON, Texas—Despite residents’ concerns and a continuing need for services, the 25-bed hospital that served […]

By | 2017-04-02T13:28:07+00:00 January 21st, 2016|Financial, Guest Post, Health Care Reform, Learning Series, Medicare and Medicaid, Population Health, Uncategorized|Comments Off on Rural Hospitals Face Financial Pressure

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