The most important strategic security program decision that the organization can make is the framework that the organization adopts for its cyber-security and compliance program.
Behavioral health documentation is often the communication tool used by and between professionals. Records not properly documented with all relevant and important facts can prevent the next practitioner from furnishing sufficient services. The outcome can cause unintended complications.
Behavioral healthcare cuts both ways for payers and providers. Shortages of qualified expertise makes filling positions difficult to impossible, while the need for services grows on many fronts and in many populations. The Daily Briefing How 2 health systems are rethinking mental health care for a value-based world, from the Advisory Board, reinforces the connections between behavioral and physical health. This identifies tangible targets, like reducing behavioral health readmissions, for improving patient care and institutional financial health.
Payers and providers spend significant energy recruiting and retaining all levels of behavioral health professionals. The access to psychiatrists acts as the 'canary in a coal mine' signalling the impending challenges. Lacking mental health expertise hits organizations at a time of increasing use spurred on by value-based care.
Massachusetts bill (H 1070/S 1093) adds to the definition of “medically necessary services” and challenges the notion of who decides medical necessity. Medical necessity criteria sits at the center of case and claim determinations. Laws, policies, and procedures evolve through time and the various administrations both locally and nationally.
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.
Fighting the health plan disconnect to members and provider networks takes diligence and the basic understanding of customer needs. The technology tools integrated into consumers' everyday lives set a very high expectation for services from their health plans and service providers.
WannaCry ransomware attack jumped cyber threat levels to new heights. Particularly hard hit were healthcare facilities in the UK. Three news articles summarize the attack and address healthcare industry's vulnerability. The US missed the brunt of the lockdown because of an accident in the form of an entrepreneurial coder inadvertently tripping the "kill switch". Cyber-attacks vulnerable healthcare industries missed the 10 years of preparation.
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.
Both payers and providers cannot find enough specialized talent for reviewing complex cases and claims, especially, behavioral health care. This unfortunately leads to in-house staff making decisions and hoping the decisions stick. Revenue processes need razor-thin efficiency in this new age of healthcare and using experienced personnel for making high risk decisions makes the most of your resources.