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 promises of value-based payment models came to life within the last 12+ months with results of real world tests. They quickly move to the implementation of useful models and processes. With ramped-up implementations overcoming value-based care barriers step out as real things.
It is important to acknowledge that CMOs and CFOs speak different languages, have different perspectives and focus on different goals. It is absolutely critical for clinical and financial leaders to recognize and understand the pain points of their colleagues on the other side of the C-suite. The need for CMO-CFO collaboration is just as evident in the financial realm of health care organizations.
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.
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.
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.
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.
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.
A new study sheds light on another repercussion of the opioid epidemic, and how it is adding to the nations ballooning health care costs and who is shouldering that burden.
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.