Resources by BHM Healthcare Solutions

Social Determinants of Health Generate Drastic Cost Reductions

May 29, 2018

New research released by WellCare Health Plans, Inc. and the University of South Florida (USF) College of Public Health, Tampa, and published in Population Health Management, reports that healthcare spending is substantially reduced when people are successfully connected to social services that address social barriers, or social determinants of health, such as secure housing, medical transportation, healthy food programs, and utility and financial assistance.

CDC: America’s Uninsured Rate Rising During Trump’s First Year

May 22, 2018

The Trump Administration released “American Patients First,” the President’s blueprint to lower drug prices and reduce out-of-pocket costs. When it comes to the cost of prescription drugs, our healthcare system faces four major challenges: high list prices for drugs; seniors and government programs overpaying for drugs due to lack of the latest negotiation tools; out-of-pocket costs for consumers; and foreign governments free-riding off of American investment in innovation.

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Members Want Provider Networks With Strong Online Presence

May 22, 2018

Medical review is the collection of information and clinical review of medical records by physician advisors (for providers reviewing cases before submissions) or a peer review team (for payers) to ensure that payment is made only for services that meet coverage, coding, and medical necessity requirements.

Here are 10 instances which can help you better identify when its time to look for a partner.

Trump Administration Plan To Lower Drug Prices and Reduce Costs

May 15, 2018

Study: Hospital Prices Show ‘mind-boggling’ Variation

May 15, 2018

The prices hospitals negotiate with health insurance companies vary enormously within and across geographic regions in the United States, according to a new study coauthored by Zack Cooper (Yale), Stuart Craig (University of Pennsylvania), Martin Gaynor (Carnegie Mellon), and John Van Reenen (London School of Economics).

Medical necessity criteria are one of the backbones of great clinical decision making

Physician Shortage Trend Cause for Concern

May 8, 2018

Analyzing your revenue cycle from start to finish can lead to recouping significant revenue dollars for your organization. Knowing what are the most impactful metrics sets revenue cycle experts apart.

Mayo Clinic Guidelines Cut Opioid Prescriptions

May 8, 2018

WEA Trust, a Wisconsin-based not-for-profit insurer, does that by protecting patients prescribed opioids for the first time. Its pharmacy utilization management program limits initial opioid prescriptions to a seven-day supply. WEA Trust also collaborates with providers to ensure opioid prescriptions are evidence-based and medically appropriate. In just five months, opiate prescriptions dropped 27 percent, with 91,000 fewer pills dispensed.

Survey Results Define CMO Responsibilities

CMS Prioritizes Patient-Centered Care over Paperwork

May 1, 2018

A new survey exams the attitudes, perspectives, and plans of healthcare leadership that are shaping telemedicine’s application, value, and potential. The research explored telehealth services adoption rates and drivers, budgets and ROI, the technology’s role in delivering care, and the factors important to executives when selecting a solution for their organization.

Study Finds Flaws in Physician Performance Metrics

May 1, 2018

Health Plan Strategies For Member Retention

April 24, 2018

Healthcare is a labor-driven service that depends on the talent and skills of every staff member, from the C-suite to nurses. Finding and keeping this talent is paramount to running a cost-effective organization that provides exceptional care was an observation from an article by Mackenzie Bean by Becker Hospital Review. Growing turnover rates significantly impact profitability.

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