BHM Blog 2017-08-24T17:18:45+00:00

Sharing what we learn begins here

Key Payer Competitive Differentiator: Analytics

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.

EHR Documentation Stretching Reimbursement Cycles?

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.

Payers Increasing Member Value Through Payment Initiatives

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.

Provider-Sponsored Health Plans: Executive Perspectives

Provider-sponsored health plans struggle through the ever-changing political environment. 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.

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.

Highly Successful ACOs: 3 Innovative Best Practices

 The URAC Report stated Accountable care may still be a relatively new model in some areas, but the numbers of highly successful ACOs are steadily increasing. There were approximately 660 ACOs in the U.S. in 2015. The number increased to 838 last year. Success, however, can be elusive.

Margin Defense & Revenue Cycle Management: 8 Challenges

Payers and providers connect, both formally and informally, through the reimbursement process. In past times, the relationships were stormy. Today, market forces push the need for better understanding of margin defense and revenue cycle performance. Streamlining internal operations addresses many of these new market demands. For example, patients demand higher value for care pushing more review of claims which push greater need for consistent documentation.  

Health Trends Highlights: Health, United States Annual Report

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.

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