Resources from BHM Healthcare Solutions

Payer-Provider Joint Ventures Gain Steam

December 5, 2016

An article in Managed Healthcare Executive, reports that joint ventures are gaining steam as plans and providers look for ways to work together to provide higher-value care.

About 13% of all U.S. health systems offer health plans, covering about 18 million members—or 8% of insured lives. according to a report from McKinsey & Company. Also according to the company, the number of provider-owned health plans is increasing about 6% each year.

Avoid Clinical Documentation ‘gotcha’s

November 30, 2016

Clinical documentation is critical for Centers for Medicare and Medicaid Services (CMS) bundles. As CMS adds more bundles to their list, clinical documentation improvements increase in value.

2017 Medical Costs Stabilize

November 28, 2016

2017 medical costs stabilize near the same rate as 2016. Signs point to larger increases in the future. At least, according to a report going behind the healthcare numbers by…

Humana Spent $93M in Quality Payments

November 21, 2016

Humana reimbursed more than $93.6 million to more than 4,000 provider groups countrywide participating in their Provider Quality Rewards Program. These particular healthcare providers received these quality payments due to value-based care improvements.

What A Difference A Day Makes: Healthcare Opportunities

November 11, 2016

The contentious US presidential election ending with a surprise (to Democrats) and created an eventful November 9th stock trading day. Now the congratulations and celebrations settled down, healthcare experts turn their sights to 2017.

Healthcare evolved significantly over the past decade, or so. Policy changes brought opportunities for organizations with continuous improvement strategies. Today, the Republican controlled government prepares to adapt and improve care and access. Policies will change, and the nimble organizations will adapt and grow.

Trump Presidency: Its Effect on Healthcare

November 9, 2016

A country-wide sinkhole just opened under the healthcare landscape, at least that is the reporting from a MarketWatch.com article. The Republican Party’s triple win means “the worst possible outcome for [health care] stocks is a reality,” said Mizuho analyst Sheryl Skolnick, since eliminating the ACA would have tremendous implications across “virtually every sub-sector“ and “we have no idea what will replace it.” MarketWatch.com

What Health Plans Must Do To Address Healthcare Trends?

November 3, 2016

The U.S. election looks to push a teetering ACA in any direction. The coming open enrollment periods will also influence the 2017 reactions from Health Plans and Providers.

Gregory Scott, US Health Plans leader and vice chairman of Deloitte LLP (profile), shares his perspective on trends impacting health plans as they respond to the rise of consumerism and the proliferation of the value-based care model.

Key for Strengthening Employer-Payer Relationship

November 2, 2016

For a variety of reasons, some businesses choose employer-sponsored health plans instead of relying on commercial payers. The employer-payer relationship struggles in recent years because of a general lack of price transparency. This lack of price transparency continues pushing companies toward self-funding health plans.

New Research Shows ACOs Improve Population Health Management and Re-admission Rates

October 31, 2016

New research shows that accountable care organizations are partnering with community resources and social service agencies to improve population health management according to a new report from Performance Evaluation: What Is Working In Accountable Care Organizations? Highlights from the study are presented here.
Private payers and the alternative payment models they’ve used among accountable care organizations have shown mixed results, but coordinating with social service agencies may bring improvements in population health management. Coordination with community centers will take the hospital-centered approach to healthcare in a significantly and positive direction, the report states.

5 Tips for Choosing Physician Advisor Services

October 18, 2016

Choosing the right Physician Advisor Services can be difficult. It’s important to look for a Physician Advisor Services 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.

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