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.
New research shows that accountable care organizations are partnering with community resources and social service agencies to improve population health management according to a new report from Performance Evaluation: What Is Working In Accountable Care Organizations? Highlights from the study are presented here. Private payers and the alternative payment models they’ve used among accountable care organizations have shown mixed results, but coordinating with social service agencies may bring improvements in population health management. Coordination with community centers will take the hospital-centered approach to healthcare in a significantly and positive direction, the report states.
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 shift to accountable care and value based payment models is coming. Accountable Care Organizations (ACOs) are just one of the value-based models making waves throughout the healthcare industry. Based on current growth trends it is predicted by 2020 approximately 70 million people will be covered by ACOs. Focusing on shared accountability and quality improvement, ACOs have become champions of the healthcare triple aim. Not to mention a major player in CMS’ plan to tie a large percentage of payments to value by 2017. As ACOs soar in popularity now is the time to weigh your options. Are you are thinking or making the transition to an ACO? What are the benefits
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.
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.