Blog Archives

Most Bang: Impactful Metrics For RCM

Analyzing Your Revenue Cycle

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.

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Posted in Financial, Financial Analysis, Services

Value-Based Payment Models and the Future of Healthcare

Bundled Payments

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.

Posted in Financial, Health Care Reform

More Competition? Specialty Pharmacy Growth

The benefits of Specialty Pharmacies for hospitals and health systems

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.

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Posted in Accreditation, Care Coordination, Clinical Operations Improvement, Financial, Healthcare Prevention, Pharmacy Accreditation, Readmissions, Revenue Cycle Improvement, Specialty Pharmacy Accreditation

Understanding Value Based Reimbursement

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.

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Posted in Financial, Financial Analysis, Health Care Reform, Health Insurance

Opioid Epidemic Fueling Hospitalizations, Hospital Costs

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.

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Posted in Financial

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

Drug Plan payment models

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.

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Posted in Financial, Medicare and Medicaid, Webinar

California Insurance Marketplace Imposes New Quality, Cost Conditions On Plans

California Health Insurance Marketplace

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.

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Posted in Financial, Health Insurance, Health Insurance Exchange, Quality Improvement Programs

Alabama Puts Hospitals At Forefront Of Medicaid Managed Care

Medicaid Managed Care

Despite having one of the strictest eligibility requirements in the country, Alabama has struggled to control the rising costs of Medicaid, which provides health coverage to more than 1 million residents. The state last week won federal approval to shift most of its Medicaid recipients into managed care organizations, which are paid a fixed monthly fee from the state for each person in the plan. It’s a strategy employed by about three dozen states, many for decades, to provide more predictable spending.

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Posted in Financial, Health Care Reform, Managed Care, Medicare and Medicaid

Deal On New Managed Care Tax Imminent in California

New Managed Care Tax

Two major players in the health insurance industry have endorsed a proposed new tax on managed care plans after seven months of challenging negotiations aimed at preventing huge state budget cuts. The revamped tax, included in a bill that was filed Monday in both houses of the state legislature, is needed to avoid a $1.1 billion hole in the state’s health care budget come June. It replaces a similar levy that will expire June 30 after being rejected by the federal government.

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Posted in Financial, Guest Post, Health Care Reform, Managed Care

Last Chance to Register! Free Webinar: Medicaid Reform in 2016

medicaid reform in 2016 webinar

Join BHM Healthcare Solutions on Friday Feb 12th, 2016 at 12:00 pm EST for the free webinar: Medicaid Reform: What You Need to Know for 2016 – the Care, Cost, Quality Challenge. Learn about Medicaid Reform changes which will be implemented in 2016 with a specific examination of state changes, delivery models, payment impacts, and trends. This expert led live event will be hosted by Robin Hamel Tzivanis.

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Posted in Accountable Care Organizations, Financial, Health Care Reform, Learning Series, Medicare and Medicaid, News and Events, Webinar

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