The Triple Aim, Explained.
With hospitals moving toward a value-based payment system there is more demand now than ever for strategies that will help healthcare systems hone in on population health. The Triple Aim, an initiative set forth by the Institute for Healthcare Improvement, covers three main checkpoints for all hospitals as they make this transition.
Telemedicine / Telehealth – Current Uses and Reimbursement
What’s better than knowing you can connect a provider with a patient even when that patient lives in the most rural of places? Telemedicine is an innovative and resourceful communication tool that integrates communications with modern day electronics allowing for the provider and patient to be in different locations during scheduled appointments. Products such as real time audio/video, email and smart phones are just some of the products being used in this delivery of services. The term telehealth which also encompasses telemedicine is a broader definition of remote healthcare that can include non clinical usage such as continuing education and training for providers to support healthcare services.
Show Me the Money | Profitability Through Value-Based Purchasing
Summary: Are you ready for a shift in risk from payer to provider? Will you be ready for value-based purchasing when it becomes required? Are you utilizing other reimbursement models such as bundled payments, Accountable Care Organizations, and Population Health Management?
From a provider perspective, healthcare reform is aimed at tightening the purse strings, working more efficiently, reducing waste, and improving quality. The shift of risk has begun which will transform healthcare from a fee-for-service to fee-for-value. When the ultimate transformation ends, is still uncertain. As such, fee-for-service is still being utilized and providers are still generating profits and revenue based on the volume mentality while simultaneously trying to transition to a volume and quantity mentality. Juggling the opposite ends of the spectrum is no easy task.
Shifting Risk: A Pharmacy Perspective on Value-Based Purchasing
Summary: In this article we will discuss Value-Based Purchasing and how it impacts the Pharma industry in particular.
According to an issue brief by Deloitte Center for Health Solutions, Value-based pricing for pharmaceuticals: Implications of the shift from volume to value, a shift in risk is occurring in the pharma industry as a result of healthcare legislation, culminating with the Affordable Care Act (ACA).
5 Aspects of CMS’ 2015 Proposed IPPS Regulations
On April 30, 2014, CMS announced proposed IPPS regulations to become effective January 1, 2015. The ruling covers: Hospital Value-Based Purchasing Program, Hospital Readmissions Reduction Program, Hospital-Acquired Condition Reduction Program, Quality Reporting Programs, and Wage Index – Updated Labor Market Areas.
CMS just announced proposed regulations to become effective January 1, 2015. These regulations further the goals of the Affordable Care Act: increasing patient outcomes and reducing healthcare spending. These proposed regulations are Medicare specific and, if approved, will be applicable to general acute care and long-term care hospitals.
New ACA Provision Calls For Cost Transparency in Hospitals
New rules put forth by the ACA will require hospitals to be transparent about the costs of care at their facility. They can do this in one of two ways: either by releasing a list of procedures and their costs, or, releasing the information after an inquiry by a patient.
Telemedicine is Expanding but Faces Obstacles
Summary: As a result of the ACA and the increase in patients while the physician shortage is magnified, efforts are under way to address the lopsidedness of supply and demand. One of those efforts is telemedicine.
The influx in individuals who are recently eligible for insurance coverage has added fuel to the fire in terms of the number of physicians who can provide care. Telemedicine is expanding in popularity and use as a means to address this issue, while also reducing healthcare costs and increasing both accessibility and affordability.
Factors Influencing ACO Expansion
Summary: What is contributing to the rapid expansion of ACOs? What programs are currently being piloted? What are the initial results of current ACOs?
What is an ACO?
An ACO is a group of healthcare providers who work together and accept accountability for reducing costs and increasing quality of care.
Benefits of ACOs to Both Patients and Providers
Summary: Accountable Care Organizations (ACOs) are gaining in popularity as a result of the Affordable Care Act. Have you considered the benefits of ACOs from both the patient and provider perspectives?
One of the goals of the Affordable Care Act (ACA) is to provide coordinated care which, in turn, increases quality and efficiency within the healthcare field, and reduces costs.
ACOs – What is an ACO?
ACOs are groups of providers which form an organization based upon the Medical Home (or PCMH) concept. The Medical Home places responsibility for the coordination of care with the primary physician. The primary care physician coordinates with other physicians and providers such as specialty physicians, laboratories and diagnostic imaging, providing a central point for the patient’s medical information.
How Are You Using Physician Data Mining?
The pay for performance model of payment has been the preference of health insurance companies for several decades. Previous models made it too easy for money to be paid for services that were not truly needed, were poorly documented or in some cases, were entirely fabricated for the purpose of payment. Pay for performance measures are meant to validate payments to physicians in accordance with The Affordable Care Act by using data mining techniques to keep tabs on physician costs.