Resources by BHM Healthcare Solutions

HEDIS Success & Value Based Care

October 3, 2016

The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by 90% of the United States’ Health Plans to measure performance on important elements of care and service. HEDIS standardizes the way health plans collect, analyze, and report data. It creates an equal playing field for all health plans (who use HEDIS) to be compared. It also can be used by employers, consultants, and patients to find the best health plan match for their needs. Many payers are now using value based reimbursement models to help meet HEDIS benchmarks. These value based programs make providers accountable for closing gaps in care and meeting HEDIS measures.

Trend Watch: Behavioral Health Integration

September 30, 2016

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.

NCQA Releases Health Insurance Plan Ratings for 2016

September 29, 2016

On September 22, 2016 the NCQA announced the release of the 2016-2017 Health Insurance Plan Ratings, this is the second year of the NCQA’s new rating methodology. The Health Insurance Plan Ratings. which are published annually and compare the quality and services of more than 1,000 health plans across the United States. One new aspect of the 2016-2017 ratings is that WebMD will be publishing the ratings on their WebMD.com.

Value Based Care Focus: The ACO

September 26, 2016

The shift to accountable care and value based payment models is coming. Accountable Care Organizations (ACOs) are just one of the value-based models making waves throughout the healthcare industry. Based on current growth trends it is predicted by 2020 approximately 70 million people will be covered by ACOs. Focusing on shared accountability and quality improvement, ACOs have become champions of the healthcare triple aim. Not to mention a major player in CMS’ plan to tie a large percentage of payments to value by 2017. As ACOs soar in popularity now is the time to weigh your options. Are you are thinking or making the transition to an ACO? What are the benefits

Making The Case for Behavioral Health Integration

September 23, 2016

Thanks to The Excellence in Mental Health Act (ExACT) passed in 2014, it’s predicted that 2016 will be a big year for Behavioral Health. As the country takes critical steps towards moving Behavioral healthcare off the back burner, demand for these services continues to grow. This will result in ample opportunity for organizations diving into Behavioral Health or BH Integration to champion the cause in 2016. But it’s important to remember that the impact of Behavioral health moves across the care continuum.

5 Tips for Choosing a Peer Review Program

September 21, 2016

Choosing the right Peer Review Program can be difficult. It’s important to look for a Peer Review Program that distinguishes itself through quality work, ongoing training, full compliance, and the latest technology. You want to trust the organization you choose and make sure they are industry certified. Use these 5 tips to help you choose a Peer Review Program or use as a guide for your current vendor.

Webinar: The Hidden Impact of Opioid Addiction

September 19, 2016

According to the Centers for Disease Control, an estimated $25 billion of U.S. healthcare costs was attributed to the abuse of painkillers—otherwise known as opioids. Up to 36 million people worldwide struggle with opioid addiction. It is a real concern for health plans and the pharmacies and providers under their umbrella. How can your health plan read the warning signs within provider networks to prevent this addiction from the start and minimize the risk and cost impact to your organization?

Survey Shows Shift in Payer Top Performers

September 16, 2016

According to a recent Revive Health Inforgraphic, the percentage of healthcare leaders who have trust in any payer is eroding over time. Revive Health conducted a survey where they targeted 201 hospital leaders who “negotiate and/or approve managed care contracts with national health insurance companies. “

1300% Spike In Opioid Epidemic Spending

September 14, 2016

The opioid epidemic sweeping the country is still in full force. As opioid dependency marks one of biggest challenges healthcare providers, payers, it has become a critical focus for everyone in the healthcare ecosystem. A recent study, reported by Kaiser Health News, found that the United States saw a 1300% spike in “spending by health insurers in a four-year period on patients with a diagnosis of opioid dependence or abuse.”

Study: More Collaboration Aids Health Care For At-Risk Populations

April 15, 2016

By teaming with community organizations, doctors and hospitals can deliver high-quality care at good value to disadvantaged people at risk for poor health, according to a new report from a panel of experts. The report released Thursday by the National Academies of Sciences, Engineering and Medicine was produced to aid Medicare officials studying how to fairly pay hospitals that disproportionately serve patients with social risk factors for health problems. Those factors include low income, social isolation, disadvantaged neighborhoods and limited health literacy.

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