News of data breaches and cyberattacks have been ruling the headlines since early 2015. In fact, out of the 14 largest healthcare data breaches 5 occurred in 2015. As cyber attacks become more common it’s crucial for healthcare organizations to learn how to protect themselves, and their patient’s data, from breaches and attacks.
Understanding the difference between Utilization Review and Utilization Management is 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.
A new study sheds light on another repercussion of the opioid epidemic, and how it is adding to the nations ballooning health care costs and who is shouldering that burden.
The healthcare industry is taking critical steps towards moving behavioral healthcare off the back burner and into the spotlight. As demand for behavioral and mental health services across the continuum of care continues to grow, there is wide spread opportunity for healthcare organizations to become champions for primary care and behavioral health integration.
On April 26, 2016 the Department of Health and Human Services (HHS) announced the finalized version of a new rule on managed care in Medicaid and the Children’s Health Insurance Program (CHIP). The “rule advances delivery system reform, strengthens quality and consumer protections, promotes accountability, and aligns Medicaid managed care rules with other health insurance coverage programs.”
The Centers for Medicare and Medicaid Services (CMS) announced the launch of Comprehensive Primary Care Plus (CPC+), a new initiative that hopes to help transform and improve the ways primary care is delivered and paid for. CPC+ will help primary care practices move away from traditional fee-for-service models and the “one size fits all” mentality, to a more unified system of care where doctors have the freedom to provide the highest quality targeted care for their patients.
Drug treatment providers in California and elsewhere have relied for decades on abstinence and therapy to treat addicts. In recent years, they’ve turned to medication. Faced with a worsening opiate epidemic and rising numbers of overdose deaths, policymakers are ramping up medication-assisted treatment. President Barack Obama last week said he’d allocate more money for states to expand access to the medications. He also proposed that physicians be able to prescribe one of the most effective anti-addiction drugs, buprenorphine, to more patients.
The role of the Independent Review Organization (IRO) in the appeals process is to provide an unbiased 3rd party opinion on complicated reviews, helping to assure that all reviews are given the time and care they deserve. It’s a common illusions in the healthcare industry that taking care of things in house is the best and easiest way to save money—however this isn’t true when it comes to claim reviews. If you are trying to manage your denials in-house, it can actually be counterproductive if you’re trying to save money and even time. Let’s take a look at how outsourcing your IROs can save you time and money.
By teaming with community organizations, doctors and hospitals can deliver high-quality care at good value to disadvantaged people at risk for poor health, according to a new report from a panel of experts. The report released Thursday by the National Academies of Sciences, Engineering and Medicine was produced to aid Medicare officials studying how to fairly pay hospitals that disproportionately serve patients with social risk factors for health problems. Those factors include low income, social isolation, disadvantaged neighborhoods and limited health literacy.
Moving into a realm usually reserved for health care regulators, the California health marketplace Thursday unveiled sweeping reforms to its contracts with insurers, seeking to improve the quality of care, curb its cost and increase transparency for consumers. The attempt to impose quality and cost standards on health plans and doctors and hospitals appears to be the first by any Obamacare exchange in the nation. Among the biggest changes: Health plans will be required to dock hospitals at least 6 percent of their payments if they do not meet certain quality standards, or give them bonuses of an equal amount if they exceed the standards.
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