Health Care Reform Archives - Page 4 of 31 - BHM Healthcare Solutions

BCRA, AHCA, and ACA: Winners and Losers

2023-08-13T16:36:41-04:00By Eric Duchinsky|Health Care Reform, Health Insurance, Health Insurance Exchange|

The Senate released its version (a.k.a. Better Care Reconciliation Act BCRA) of the House's AHCA. Payers and providers adjust as needed because healthcare reforms, like BCRA, AHCA, and ACA, continuously move through state and federal legislatures. Today's blog, pulls together summaries from numerous resources allowing you a quick glimpse or a deep dive into what waits around the corner. Here are 10 instances which can help you better identify when its time to look for a partner.

Not Waiting For Capitol Hill: Health System Leaders Move Ahead

2017-05-23T19:29:16-04:00By Eric Duchinsky|Clinical Operations Improvement, Compliance, Financial, Financial Analysis, Health Care Reform|

Despite industry uncertainty about the fate of healthcare under the new administration and Republican Congress, health system leaders move ahead and are preparing for the future. A recent Premier Inc. survey show the target areas for improvements within their systems. The results signal growth concerns and why the leaders will not wait for Capitol Hill results.

Out of Box Ideas: Prior Authorization Reform?

2017-05-17T12:45:42-04:00By Eric Duchinsky|Health Care Reform, Physician Advisor/Peer Review, Services|

Responding to unreasonable hurdles for patients seeking care, a coalition including the American Medical Association (AMA) and 16 other health care organizations today urged health plans, benefit managers and others to propose prior authorization reform requirements imposed on medical tests, procedures, devices, and drugs.

AHCA and Three Scenarios: Repeal, Replace, Repair

2017-05-03T20:18:06-04:00By Eric Duchinsky|Health Care Reform, Health Insurance, Health Insurance Exchange|

Any similarities of the title of this blog and Goldilocks and the Three Bears belies the serious decisions needed for the next round of healthcare reform. Last month, PwC’s Health Research Institute (HRI) released another fantastic research piece that maps out three possible landing spots: repeal, replace, repair. Here are 10 instances which can help you better identify when its time to look for a partner.

Delegation For Workers Compensation

2017-06-09T10:24:41-04:00By Eric Duchinsky|Health Care Reform, IRO, Physician Advisor/Peer Review, Uncategorized|

Across the country more and more workers compensation organizations are utilizing Workers Compensation Independent Medical Reviews to keep claims on track, and to decrease unnecessary expenditures as they relate to legal proceedings. When choosing an independent medical review network ask if they offer delegation for workers compensation medical reviews. Delegation provides an opportunity for significantly lower administration expenses wile increasing the quality of reviews.

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

2017-12-01T11:43:58-04:00By Eric Duchinsky|Accountable Care Organizations, Health Care Reform, Health Insurance|

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.

Value-Based Payment Models and the Future of Healthcare

2023-09-11T15:28:00-04:00By BHM Marketing|Financial, Health Care Reform, Uncategorized|

The Centers for Medicare & Medicaid Services (CMS) has been pushing value based models that focus on quality of care rather than quantity. This means that most traditional incentive based payment models are being put phased out. The CMS hopes to tie 90% of all Medicare payments to alternative payment methods by 2018. Unlike fee-for-service models, value based models tie quality and cost together. By doing this they can encourage providers to give the best possible care at the best possible cost.

Value Based Care Focus: The ACO

2017-07-05T15:12:32-04:00By BHM Marketing|Accountable Care Organizations, Health Care Reform, Medicare and Medicaid, Organizational Analysis, Strategic Planning|

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

Alternative Payment Models Critical to Healthcare Change

2023-09-08T15:32:50-04:00By Eric Duchinsky|Accountable Care Organizations, Health Care Reform|

Traditional incentive based payment models are being put phased out. The Centers for Medicare & Medicaid Services (CMS) is now pushing for alternative payment models that focus on quality of care rather than quantity. The CMS hopes to tie 90% of all Medicare payments to alternative payment methods by 2018. To support this transition CMS has proposed changes to the Medicare Access and CHIP Reauthorization Act (MACRA), which focuses on changing the way providers are reimbursed for care.

Provider-Owned Health Plans Make Noise

2023-08-07T14:36:42-04:00By Eric Duchinsky|Health Care Reform|

Provider-owned health plans have been gaining momentum since the roll out of the Affordable Care Act and the impending shift from fee-for-service to value-based payment models. For providers hoping to get a handle on healthcare costs and supplement their own medical data with claims data, launching a health plan has been a strategic move.

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