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Challenges of Developing Workers Compensation Treatment Guidelines

May 23, 2017

Workers compensation treatment guidelines can help prevent unnecessary medical procedures and the prescribing of potentially harmful medications. However, they are not all the same, nor are they without challenges. Understanding a jurisdiction’s strengths/weaknesses, taking a strategic approach to developing guidelines, and using common sense can lead to better outcomes for injured workers—and, ultimately, lower costs for payers.

Not Waiting For Capitol Hill: Health System Leaders Move Ahead

May 23, 2017

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.

Update: Payer Efforts Against Opioid Epidemic

May 23, 2017

According to the CDC, drug overdoses are the leading cause of accidental death in the United States. Of the overdose deaths that occurred in 2015, 63 percent involved an opioid. Payer options for managing efforts against opioid overuse range from monitoring population data to working with provider networks.

Removing Value-Based Care Barriers

May 22, 2017

The promises of value-based payment models came to life within the last 12+ months with results of real world tests. They quickly move to the implementation of useful models and processes. With ramped-up implementations overcoming value-based care barriers step out as real things.

Fight The Health Plan Disconnect To Members

May 22, 2017

Fighting the health plan disconnect to members and provider networks takes diligence and the basic understanding of customer needs. The technology tools integrated into consumers’ everyday lives set a very high expectation for services from their health plans and service providers.

Cyber-attacks Vulnerable Healthcare Industries

May 17, 2017

WannaCry ransomware attack jumped cyber threat levels to new heights. Particularly hard hit were healthcare facilities in the UK. Three news articles summarize the attack and address healthcare industry’s vulnerability. The US missed the brunt of the lockdown because of an accident in the form of an entrepreneurial coder inadvertently tripping the “kill switch”. Cyber-attacks vulnerable healthcare industries missed the 10 years of preparation.

Out of Box Ideas: Prior Authorization Reform?

May 17, 2017

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.

CMO-CFO Collaboration Marks Success

May 8, 2017

It is important to acknowledge that CMOs and CFOs speak different languages, have different perspectives and focus on different goals. It is absolutely critical for clinical and financial leaders to recognize and understand the pain points of their colleagues on the other side of the C-suite. The need for CMO-CFO collaboration is just as evident in the financial realm of health care organizations.

Outsourcing Complex Claims and Cases Review

May 8, 2017

Both payers and providers cannot find enough specialized talent for reviewing complex cases and claims, especially, behavioral health care. This unfortunately leads to in-house staff making decisions and hoping the decisions stick. Revenue processes need razor-thin efficiency in this new age of healthcare and using experienced personnel for making high risk decisions makes the most of your resources.

AHCA and Three Scenarios: Repeal, Replace, Repair

May 3, 2017

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.

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Challenges of Developing Workers Compensation Treatment Guidelines

Not Waiting For Capitol Hill: Health System Leaders Move Ahead

Update: Payer Efforts Against Opioid Epidemic

Removing Value-Based Care Barriers

Fight The Health Plan Disconnect To Members

Cyber-attacks Vulnerable Healthcare Industries

Out of Box Ideas: Prior Authorization Reform?

CMO-CFO Collaboration Marks Success

Outsourcing Complex Claims and Cases Review

AHCA and Three Scenarios: Repeal, Replace, Repair

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