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.
The healthcare industry is rapidly changing and growing. Healthcare reform in one of the biggest factors to jump-starts change in all aspects of a healthcare organization. The rapid shift to value based performance and consumer outcomes, from fee-for-service payment, puts Healthcare Transformation Assistance programs and services in the forefront of change. They are designed to assist your organization in this rapidly evolving environment.
The Patient Centered Medical Home is very important model of care that has been growing in popularity across the national. The PCMH is not specific place but more a model of care focused on accessible, coordinated, comprehensive, and patient centered care. PCMH are also committed to and is committed to quality and safety. The PCMH model is a great way for primary care organizations to put a stronger emphasis on care coordination and communication, which in turn helps transform primary care to be more patient-centered.
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.
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
The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used for health care performance measurement. Called the “Gold Standard” by the NCQA, HEDIS is used by 90% […]
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.
In April of 2016, CMS announced that a new type of tool to help consumers compare the breadth of plans’ networks on HealthCare.gov. A recent update to that announcement (September 2016) has notified the public that the roll out should start in 2017, for a small number of states.
Optimizing your revenue cycle starts with reducing denials. In order to do this, you must have an effective Denial Management strategy in place. According to a new HIMSS Analytics study, 56% of hospitals surveyed said they don’t use a vendor solution for claim denials. However, around 60% of those respondents are planning on purchasing a claims denials management tool within the next year. If you are part of the 40%, now may be the time to think about investing in tools for claims denials.
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.