5 Medical Cost Pressures Shaping 2018

The era of volatile swings and double-digit growth in employer medical costs appears to be ending. With medical cost trend hovering in the single digits for several years, the industry has been waiting for the inflection point when spending will take off. But that spike appears unlikely to happen. The New Health Economy is settling into a “new normal,” typically characterized by more attenuated fluctuations and a single-digit trend.For four years, medical cost trend has hung between 6 and 7 percent, seeming to settle into a “new normal.” PwC’s Health Research Institute (HRI) anticipates a 6.5 percent growth rate for calendar year 2018, half a percentage point higher than in 2017.

4 Targets For Resource Improvement

Many hospitals are currently asking themselves, "How can we improve our revenue cycle in 2015?" This topic is also one many C-suite executives are facing in 2015, which is proving to be another year of vast changes. Financial departments will have to stay on top of contract management, as well as planning for shifts in how payments are received. Today, we've put together a list of 5 ways healthcare providers can reboot their revenue cycles and stay ahead of those changes that impact the bottom line.

Data Management Is Denial Management

You know your reimbursement process needs attention when the response to an adverse determination is to resend the exact same paperwork through the pipeline. In a few cases, the ROI on a resend appears reasonable, but peel back the band-aid and you will find a process needing attention. Understanding data management is denial management begins the healing process.

Payers and Providers Value-Based Care Reimbursement

Value-based care reimbursement models (VBR) are becoming a popular choice for many healthcare providers and payers, as fee-for-service, (and traditional incentive based payment models), are phased out. According to a recent McKesson survey “Journey to Value: The State of Value-Based Reimbursement in 2016," 58% of payers and hospitals are planning to adopt value-based care reimbursement models.

6 Tips for Reducing Claims Denials

Optimizing your revenue cycle starts with reducing denials. In order to do this, you must have an effective Denial Management strategy in place. According to a new HIMSS Analytics study, 56% of hospitals surveyed said they don’t use a vendor solution for claim denials. However, around 60% of those respondents are planning on purchasing a claims denials management tool within the next year. If you are part of the 40%, now may be the time to think about investing in tools for claims denials.

Turn Your Denials Around: Denial Management Focus

Health insurance claim denials could be causing your organization to lose a significant amount of revenue each year. An effective Denial Management strategy is one of the fastest ways to recoup lost revenue, and ensure that you are being paid for the care that you are providing. Studies indicate that approximately 25-30% of healthcare claims are rejected or denied. This results in millions of dollars of lost revenue each year. The majority of these losses can be avoided by implementing our unique denial management process.

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.

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