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.
Responding to unreasonable hurdles for patients seeking care, a coalition including the American Medical Association (AMA) and 16 other health care organizations today urged health plans, benefit managers and others to propose prior authorization reform requirements imposed on medical tests, procedures, devices, and drugs.
Any similarities of the title of this blog and Goldilocks and the Three Bears belies the serious decisions needed for the next round of healthcare reform. Last month, PwC’s Health Research Institute (HRI) released another fantastic research piece that maps out three possible landing spots: repeal, replace, repair. Here are 10 instances which can help you better identify when its time to look for a partner.
Across the country more and more workers compensation organizations are utilizing Workers Compensation Independent Medical Reviews to keep claims on track, and to decrease unnecessary expenditures as they relate to legal proceedings. When choosing an independent medical review network ask if they offer delegation for workers compensation medical reviews. Delegation provides an opportunity for significantly lower administration expenses wile increasing the quality of reviews.
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.
Traditional incentive based payment models are being put phased out. The Centers for Medicare & Medicaid Services (CMS) is now pushing for alternative payment models that focus on quality of care rather than quantity. The CMS hopes to tie 90% of all Medicare payments to alternative payment methods by 2018. To support this transition CMS has proposed changes to the Medicare Access and CHIP Reauthorization Act (MACRA), which focuses on changing the way providers are reimbursed for care.
Signed into law in 2015, the Medicare Access and CHIP Reauthorization Act (MACRA), centers on reimbursing providers for the value and quality of care they provide. The MACRA Quality Payment Program (QPP) is a proposed shift to the law itself and many healthcare organizations weighing-in.
Provider-owned health plans have been gaining momentum since the roll out of the Affordable Care Act and the impending shift from fee-for-service to value-based payment models. For providers hoping to get a handle on healthcare costs and supplement their own medical data with claims data, launching a health plan has been a strategic move.
The healthcare industry is undergoing an inevitable shift away from fee for service payment models towards reimbursement models that align with the healthcare triple aim, such as value based payments. The approach and question of which value-based model to implement still remains elusive for many organizations. Let’s take a look at some payment types on the value-based reimbursement spectrum.
The opioid epidemic is a real concern, not only for the patients and providers but also for payors and health plans. According to a study by the Centers for Disease Control and Prevention, there could be correlation between insurers picking up the costs on pain drugs and the rise of opioid related deaths.