Hospital Readmissions penalties run high as the government plans to penalize more than half of the nation’s hospitals. Over the next year Medicare plans to withhold more than a half a billion dollars in payments, reports Kaiser Health news. In 2015 alone hospital readmissions penalties hit a total of $420 million¹.
The number of Accountable Care Organizations (ACOs) in the U.S. is growing rapidly, causing major shift in the healthcare landscape. ACOs are provider lead organization with a strong primary care base. What makes them different from other healthcare models is that ACOs are collectively accountable for quality, costs and the full continuum of care for their patients. Encouraged by the Affordable Care Act, this type of shared-risk model, which also falls under value-based, is becoming a good option for many providers.
Healthcare trends are crucial to watch, as they help organizations predict changes in the industry and can help then make critical improvements to the way they do business. In previous week’s we looked at payer trends and payment trends. This week we are homing in on medical cost trends for 2017. From retail clinics to PBMs, there are many trends impacting healthcare spending.
The Centers for Medicare & Medicaid Services released the final version of its hospital quality ratings Wednesday and posted them to the Hospital Compare website. Many of the most well-known hospitals in the nation received below average scores while lesser known facilities took the top scores.
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.
The demand for behavioral health services across the continuum of care is high, with 20.1% of adults with a mental illness reporting that they are unable to get the treatment they need. However a major shift in healthcare could be on the horizon. On July 6, 2016, The House of Representatives passed The Helping Families in Mental Health Crisis Act, a bill focused on mental health reform. Many are saying it’s the most significant bill targeting mental health since the 1963¹.
Q3 is in full swing and now is the time to look at what healthcare trends will bring us into 2017. Many payers are looking at current healthcare trends to help predict changes in the marketplace and isolate places of improvement. From data security to value based payments, it has been a big year for healthcare. Here 4 of the biggest trends payers can expect to hit in Q4 and continue into 2017.
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.
Patient Centered Medical Homes (PCMH) value based care model growing across the United States. PCMHs aren’t actually places but care models based on providing care which is accessible, coordinated, and comprehensive. PCMHs focus on patient centered care and are committed to quality and safety.
The Centers for Medicare & Medicaid Services (CMS) finalized a new rule that gives providers and employers better access to Medicare and private sector claims data. CMS hopes that the improved access will help organizations make more informed decisions about care delivery and quality improvement.
Copyright 2025 © All rights Reserved.
