The federal government hit CVS Health and Centene with lower quality scores for the health-insurance plans they sell to seniors. Star Rating scores are a big deal for health insurers, because plans that score 4 stars or higher receive bonus payments from the federal government that they can use to edge out competition by funding new health-plan benefits to attract more customers.
Utilization Review and Utilization Management are very critical in the healthcare continuum. While the two terms often feel interchangeable, in reality their processes and meanings actually are very different. Their differences make all the difference for improving care.
Discharge planning is the development of a personalized plan to ensure the smooth transition of a patient from a health organization such as a hospital to wherever the patient is going next such as a home, residential care, palliative care or somewhere else.
ASAM Criteria set guidelines for length of stay and level of care for behavioral health. BHM Healthcare Solutions offers objective peer reviews based on medical necessity criteria, like ASAM's, for complex, medical, and behavioral health cases.
Back in March, we talked about how the role of the pharmacist in the healthcare ecosystem has been expanding over the past decade. In addition to simple medication fulfillment, pharmacist now complete crucial patient aftercare, education, and vaccination administration. Many believe as the role of the pharmacist expands, they could become the key to reducing all kinds of healthcare costs. Here are three ways pharmacy is helping save costs for healthcare.
The role of the pharmacist in the healthcare industry has been expanding over the past decade, from simple medication fulfillment to crucial patient aftercare, education, and administering vaccinations. 2015 has already seen big changes within the healthcare industry and we predict that the role of the pharmacist will only expand more.
It’s unclear whether President Obama’s request for funding to combat HAIs will be met by Congress, but regardless of whether or not the funding comes from the federal government, hospitals will need to find the money somewhere to continue investing in HAI prevention, especially as it becomes more inextricably linked with reimbursement as we march forward this year.
For the third year in a row, Medicare will be increasing the percent penalty for hospitals who have high readmission rates: up now to 3% in 2015. Despite efforts through the ACA and readmission reductions programs, the rate of readmissions continues to rise. Initially, Medicare attempted to stifle this by forcing hospitals to be transparent about their numbers. By making the number of readmissions public, the hope was that there would be a certain accountability and hospitals would then attempt to discern why their rates were so high. When this didn’t prove to drop the rates as much as Medicare would have hoped, they tacked on a financial penalty that hospitals would need to pay if their rates continued to rise.
No hospital will ever achieve a zero readmission rate--nor would they want to, as it may be an indicator of poor quality of care. However, there are many factors that lead to higher readmission rates--some of which can be avoided or at least more properly managed. In today's post, we'll discuss some of those factors as well as how they can be addressed.
Healthcare has become something of a hard science, if the focus on data and numbers is any indication. It would seem that the research, the endless reporting and spreadsheets of healthcare administration, has served to at least shed light on the problems healthcare is currently facing as an industry - but the fix isn’t likely to be in black and white.