Services Archives - Page 18 of 32 - BHM Healthcare Solutions

What ACO Obstacles are You Facing?

2017-04-02T13:28:32-04:00By BHM Marketing|Accountable Care Organizations, Services|

While many have been quick to defend the slow rise of Accountable Care Organizations (ACOs), many others are looking not at the slowness of the climb, but the inconsistency. Circling back to the entire point of ACO formation in the U.S. there were two distinct motivations: 1) the care previously provided by independent physicians was more often than not uncoordinated and 2) the fee-for-service payment model was inefficient and made the incentive for physicians providing more care not necessarily good care.

Think Like a Reviewer: Utilization Review

2017-04-02T13:28:32-04:00By BHM Marketing|Services, Utilization Management|

One of the many ways in which healthcare organizations are assessed these days is both internal and external in the form of utilization review. Internally, there are reviews done by designated staff members (who are usually nurses) who keep tabs daily on the patient care measures set forth by a hospital as tracking measures. They are reviewing the care of inpatients on any given day, trying to look for trouble spots before they become problematic. If a major event occurs within the hospital regarding patient care, an external review will need to done to help determine any disciplinary action, workflow changes or protocol alterations that might be necessary to keep it from recurring.

Accountable Care Organizations – Can They Solve the Healthcare Cost Dilemma?

2017-04-02T13:28:32-04:00By BHM Marketing|Accountable Care Organizations, Services|

Accountable Care Organizations (ACOs) are a hot button topic in healthcare right now for several reasons. First and foremost, since they are still the new kid on the block, there are some misunderstandings of just want constitutes an ACO and what the fundamental differences are from the former standard, HMOs. One of the primary focuses at the present time is establishing ACOs as being the go-to choice for patients (i.e. consumers) because it will allow them to broaden their access to healthcare services. Traditionally, in an HMO, a patient’s insurance coverage limits them to using only providers and services which are “in-network” with their insurance carrier. To seek care outside of the network of providers means more out-of-pocket payment is required of the patient. Access to care is therefore largely dictated by the insurance carrier, not the patient’s needs.

5 Issues Associated With Medical Necessity

2024-06-19T08:00:31-04:00By BHM Marketing|Physician Advisor/Peer Review, Services|

There are few things more frustrating to a physician than a pile of Medical Necessity edits. Medical Necessity is the term we use in healthcare to describe care what is reasonable and appropriate for a patient based on evidence-based care standards. This has become something of a major bone of contention between payers and physicians, because, often times, physicians don’t understand why their clinical judgment is being brought into question.

Developing Clinical Pathways

2017-04-02T13:28:32-04:00By BHM Marketing|Clinical Analysis, Services|

When it comes to patient safety, the best way to be prepared is to develop evidence-based plans and strategies to guide patients through the healthcare system. These plans are called clinical pathways. Developing Clinical Pathways Clinical pathways are being developed in hospitals nationwide to help physicians move patients through the hospital. They are designed by the hospital, for the patients, and they have many benefits.

5 Values You Should Value in Physician Compensation Models

2017-04-02T13:28:32-04:00By BHM Marketing|Financial Analysis, Physician Compensation, Quality Improvement Programs, Services|

When it comes to shifting models of physician compensation, there are many considerations ,and at times, it can be difficult to decide where your focus, as a physician or a payer, should be. As we move toward value-based payment models, we might want to consider what values already exist within our healthcare organizations that will be reflective of this shift - and by supporting them, we can lead the charge to newer payment models.

15 Ways Your Claims May Have Been Denied | Opportunities to Recoup Revenue

2017-04-02T13:28:32-04:00By BHM Marketing|Financial, Revenue Cycle Improvement, Services|

A claim could have been denied for many reasons, the question is, could any of them been prevented? Many claim denials are completely avoidable - and in fact, there are practical ways you can combat claim denials. Look at the following common claim denial reasons and see if any of them have happened to you recently:

Are ACOs Just HMOs in Disguise?

2017-04-02T13:28:32-04:00By BHM Marketing|Accountable Care Organizations, Care Coordination, Financial, Health Insurance, Services|

When we talk about Accountable Care Organizations (ACOs) , a lot of people think that they are nothing more than a second try at the ol’ Health Maintenance Organizations (HMOs) of the late 80s. ACOs may have some things in common with HMOs, but when you look a little bit closer you’ll see that there are a few very distinct elements that differentiate them.

7 Ways to Reduce ER Admissions / Re-admissions

2017-04-02T13:28:33-04:00By BHM Marketing|Clinical Analysis, Operational Analysis, Readmissions, Services|

For many hospitals, the emergency room is the busiest place for both staff and patients. Overcrowding, long wait times and inefficient care plague a lot of U.S. hospitals and there is a growing need for solutions. Not only is the overutilization costing money, but it is affecting patient satisfaction scores, meaning that hospitals aren’t meeting their annual measures. Of course, there are times in the life of any emergency room, when it’s unavoidably busy: during summer months, hospitals that are in prime vacation areas need to plan for an influx of one-time patients. In the event of a disaster or outbreak of communicable illnesses in a community, utilization of emergency room services are certain to skyrocket. But what about in general, when physicians find that they are treating patients who, ultimately, do not need emergency services - meaning that patients who do are left in a lurch?

3 Ways Providers Optimize the “Pay-for-Performance” Model of Care|Doctor’s Channel

2017-04-02T13:28:33-04:00By BHM Marketing|Financial Analysis, Health Care Reform, Physician Compensation, Services|

As part of BHM’s new partnership with The Doctor’s Channel, Anthony Grimaldi, BHM’s Senior Vice President Provider/Hospital Division, speaks about optimizing Pay-for-Performance models in healthcare. The Doctor’s Channel specializes in short, interesting video clips (generally 2 minutes or less) that educate doctors and other medical professionals on nearly any specialty imaginable. The vast video library also has many segments and series that are eligible for CME, making it an excellent resource for providers.

Services

BHM Solutions

Payers

Providers

Services

BHM Solutions

Payers

Providers

Services

BHM Solutions

Payers

Providers

Services

BHM Solutions

Payers

Providers