Many health plans are facing uncertainties: the changing health insurance landscape, the speed at which value–based care is approaching, and growing demands from customers, to name a few. But one investment may help executives meet each of these challenges—an investment in analytics. Health plans are data rich, yet those data are not always leveraged to understand what happened and why, or predict what is likely to happen. Health plans that don't take advantage of their data may risk being disrupted and left behind. Analytics can be a key payer competitive differentiator setting your organization ahead of the pack.
Payers and providers need efficient administrative services for profitability. With all the capital and human resources invested in electronic health records and data exchange security, why are documentation errors still one of the highest cause of adverse determinations? The number of claims slowed by lack of/incomplete/poor EHR documentation became crystal clear in recent reports.
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.
Over the past 40 years Health, United States provided an annual picture of the health of the United States, identified variations in health status, modifiable risk factors, and health care utilization among people by age, race and ethnicity, gender, income level, and geographic location. Examining long-term health trends inform the development and implementation of effective health policies and programs.
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.
Workers compensation treatment guidelines can help prevent unnecessary medical procedures and the prescribing of potentially harmful medications. However, they are not all the same, nor are they without challenges. Understanding a jurisdiction's strengths/weaknesses, taking a strategic approach to developing guidelines, and using common sense can lead to better outcomes for injured workers—and, ultimately, lower costs for payers.
The largest health plans share more things in common than you might imagine. Striving for the high quality patient care comes to mind. How about striving for process efficiency? Absolutely. Integrating continuous improvements move these organizations ahead of the rest.
The American Health Care Act (AHCA) made its debut. Not many people in government and healthcare industries expect quick passage of the AHCA in its initial form, but understanding the differences with the Affordable Care Act (ACA) sets a framework for how payers prepare for the final version. Fair to say, every organization must make adjustments and the pressures for building internal organization-level efficiencies increase.