Resources by BHM Healthcare Solutions

Managed Care Trends | Where Are We Headed?

2017-04-02T13:28:32-04:00By BHM Marketing|Accountable Care Organizations, Health Insurance, Managed Care|

Many people who talk about managed care don’t realize that it has actually been undergoing a bit of a renaissance since the late 1980s - and has existed conceptually since the ‘30s. Since the late ‘80s, MCOs have progressed through several phases: Phase 1: Using utilization review and pre-admission certification to manage access to care. Phase 2: The addition of fee-for-service networks and managing benefits. Phase 3: Shift from utilization review to utilization management with an emphasis on the ‘appropriateness’ of care as well as the care setting. Phase 4: The current phase of MCO development, which has only started in the last couple of years, looks at establishing a continuum of services, lessening the tendency for providers to operate in ‘silos’ which has been the dominant structure of healthcare in the U.S. for years.

BHM Wishes You a Happy Labor Day!

2014-08-31T17:11:15-04:00By BHM Marketing|Uncategorized|

BHM Healthcare Solutions would like to wish all of you a Happy and Safe Labor Day!

What ACO Obstacles are You Facing?

2017-04-02T13:28:32-04:00By BHM Marketing|Accountable Care Organizations, Services|

While many have been quick to defend the slow rise of Accountable Care Organizations (ACOs), many others are looking not at the slowness of the climb, but the inconsistency. Circling back to the entire point of ACO formation in the U.S. there were two distinct motivations: 1) the care previously provided by independent physicians was more often than not uncoordinated and 2) the fee-for-service payment model was inefficient and made the incentive for physicians providing more care not necessarily good care.

Think Like a Reviewer: Utilization Review

2017-04-02T13:28:32-04:00By BHM Marketing|Services, Utilization Management|

One of the many ways in which healthcare organizations are assessed these days is both internal and external in the form of utilization review. Internally, there are reviews done by designated staff members (who are usually nurses) who keep tabs daily on the patient care measures set forth by a hospital as tracking measures. They are reviewing the care of inpatients on any given day, trying to look for trouble spots before they become problematic. If a major event occurs within the hospital regarding patient care, an external review will need to done to help determine any disciplinary action, workflow changes or protocol alterations that might be necessary to keep it from recurring.

Accountable Care Organizations – Can They Solve the Healthcare Cost Dilemma?

2017-04-02T13:28:32-04:00By BHM Marketing|Accountable Care Organizations, Services|

Accountable Care Organizations (ACOs) are a hot button topic in healthcare right now for several reasons. First and foremost, since they are still the new kid on the block, there are some misunderstandings of just want constitutes an ACO and what the fundamental differences are from the former standard, HMOs. One of the primary focuses at the present time is establishing ACOs as being the go-to choice for patients (i.e. consumers) because it will allow them to broaden their access to healthcare services. Traditionally, in an HMO, a patient’s insurance coverage limits them to using only providers and services which are “in-network” with their insurance carrier. To seek care outside of the network of providers means more out-of-pocket payment is required of the patient. Access to care is therefore largely dictated by the insurance carrier, not the patient’s needs.

5 Issues Associated With Medical Necessity

2024-06-19T08:00:31-04:00By BHM Marketing|Physician Advisor/Peer Review, Services|

There are few things more frustrating to a physician than a pile of Medical Necessity edits. Medical Necessity is the term we use in healthcare to describe care what is reasonable and appropriate for a patient based on evidence-based care standards. This has become something of a major bone of contention between payers and physicians, because, often times, physicians don’t understand why their clinical judgment is being brought into question.

Developing Clinical Pathways

2017-04-02T13:28:32-04:00By BHM Marketing|Clinical Analysis, Services|

When it comes to patient safety, the best way to be prepared is to develop evidence-based plans and strategies to guide patients through the healthcare system. These plans are called clinical pathways. Developing Clinical Pathways Clinical pathways are being developed in hospitals nationwide to help physicians move patients through the hospital. They are designed by the hospital, for the patients, and they have many benefits.

How Telehealth Will Support the Triple Aim

2017-04-02T13:28:32-04:00By BHM Marketing|Financial Analysis, Population Health, Telehealth and Telemedicine|

You’ll recall that the Centers for Medicare and Medicaid has adopted the concept of The Triple Aim to serve as a guiding light for healthcare organizations to improve patient outcome measures. The Triple Aim has three interlocking components: 1. Improving the patient experience of care (patient satisfaction) 2. Improving the health of populations 3. Reducing the per capita cost of healthcare It probably seems fairly intuitive that these three measures would be theoretically connected. If you can improve patient health at a population level, you’ll reduce the need for costly and often unnecessary services; and if you achieve positive patient outcome measures, you’ll be reducing readmissions. This equals reduced cost.

5 Values You Should Value in Physician Compensation Models

2017-04-02T13:28:32-04:00By BHM Marketing|Financial Analysis, Physician Compensation, Quality Improvement Programs, Services|

When it comes to shifting models of physician compensation, there are many considerations ,and at times, it can be difficult to decide where your focus, as a physician or a payer, should be. As we move toward value-based payment models, we might want to consider what values already exist within our healthcare organizations that will be reflective of this shift - and by supporting them, we can lead the charge to newer payment models.

Is Your Patients’ Data Protected? | 8 Steps You Can Follow Today

2017-04-02T13:28:32-04:00By BHM Marketing|Big Data|

With so much of our personal data floating around the digital world, it is important to be able to protect it from cyber threats. Here are 8 simple steps to keeping your patients data secure.

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