New Study Reviews Payer Performance

Athena Health recently published the 2016 edition of PayerView, a in-depth review of the biggest payers in their network. Athena Health identifies the shift to value based care and healthcare reform as the biggest challenges to everyone for payers to providers.

Trend Watch: Behavioral Health Integration

Behavioral Health Integration has become one of the largest trends in healthcare this year. With one in 5 adults¹ experiencing a mental health condition each year, mental health can longer be pushed to the back burner. The demand for behavioral health services across the nation is sky rocketing, putting BH integration in an important position to help close gaps in care. It will take everyone from provider to payers breaking the stigma surrounding mental health and investing in ways to improve access to care and care outcomes.

By | 2017-04-02T13:28:01+00:00 September 30th, 2016|Behavioral Health Integration, Uncategorized|0 Comments

Best Practices for Lowering Fraud

Building strong payer/provider relationships is critical to lowering the risk of fraud. Because the nation’s health care industry uses third-party payers such as commercial insurers and Federal and State government, the relationship between payer and provider is one that needs a lot of care and attention. From coding to physical documentation, these 4 tips are outlined by the Department of Health and Human Services as the most important ingredients to successful payer-provider relationships.

By | 2017-04-02T13:28:01+00:00 September 12th, 2016|Physician Advisor/Peer Review|0 Comments

Payers Find Fix For Volatile Market Changes

Payers look to contractors for help as healthcare reform continues to drive change in the industry. From cutting costs to processing claims, there is an urgent need among payers for outsourcing. Claims management services are expected to see the biggest spike in growth in the coming years¹.

By | 2017-04-02T13:28:02+00:00 August 5th, 2016|Services|0 Comments

Mid-Year Update: 4 Major Payer Trends

Q3 is in full swing and now is the time to look at what healthcare trends will bring us into 2017. Many payers are looking at current healthcare trends to help predict changes in the marketplace and isolate places of improvement. From data security to value based payments, it has been a big year for healthcare. Here 4 of the biggest trends payers can expect to hit in Q4 and continue into 2017.

By | 2017-04-02T13:28:03+00:00 July 18th, 2016|Trends|0 Comments

Provider-Owned Health Plans Make Noise

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.

By | 2017-04-02T13:28:03+00:00 July 11th, 2016|Health Care Reform|0 Comments

Behavioral Health Integration Tips for Payers and Providers

Primary care providers are no strangers to behavioral health. Many individuals with behavioral health conditions pass through primary care settings daily. It’s reported that one in five Americans suffer from behavioral health conditions. This had lead to an estimated $57 billion per year in costs. The treatment gap is also an issue. Mental health issues are frequently unrecognized and often reimbursement for behavioral health services is not an option. This has resulted in primary care providers and payers integrating behavioral health services into model of care.

By | 2017-04-02T13:28:03+00:00 June 27th, 2016|Behavioral Health Integration|0 Comments

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