The healthcare industry is undergoing an inevitable shift away from fee for service payment models towards reimbursement models that align with the healthcare triple aim, such as value based payments. The approach and question of which value-based model to implement still remains elusive for many organizations. Let’s take a look at some payment types on the value-based reimbursement spectrum.
UnitedHealthcare announced it will be partnering with DeKalb Physician Hospital Organization in Georgia, to launch an accountable care program. The program hopes to improve both patient care and satisfaction through better coordinated care and shared risk.
Primary care providers are no strangers to behavioral health. Many individuals with behavioral health conditions pass through primary care settings daily. It’s reported that one in five Americans suffer from behavioral health conditions. This had lead to an estimated $57 billion per year in costs. The treatment gap is also an issue. Mental health issues are frequently unrecognized and often reimbursement for behavioral health services is not an option. This has resulted in primary care providers and payers integrating behavioral health services into model of care.
Accountable Care Organizations (ACOs) are a hot topic in the healthcare industry. From shared accountability to quality improvement, ACOs are fully embracing the healthcare triple aim. If you are thinking of creating an ACO now would be the time. Based on current growth trends it is predicted by 2020 approximately 70 million people will be covered by ACOs, and some industry experts estimate coverage will expand to 150 million people by 2025.
Aerospace giant Boeing Co. has agreed to contract MemorialCare Health System of Southern California directly for employee care. ACOs, which are swiftly becoming a popular model, are groups of physicians, hospitals and providers who work together to provide a continuum of care and share risk.
Peer-to-Peer and Physician Advisory Review Programs are a crucial part of driving quality improvement throughout healthcare organizations. They are key to helping organizations maintain credibility and support effective unbiased reviews. Thanks to the Affordable Care Act, consumers expect unbiased review of their care through the claims and appeals processes. Independent Review Organization have now been placed in the forefront of the healthcare industry.
The healthcare industry is constantly changing. From legislation to trends in care, it's often daunting to stay on top of the changes. Payers can rely on professional development and continuous training for staff to help keep them up to date with changes in their industry.
The shift to value based reimbursement has become inevitable, but Medicaid’s goal of tying 50 percent of all payments to value based initiatives by the end of 2016 may not be met. A recent survey by Health Catalyst shows that hospitals are slow to make the move towards value based initiatives. With only 3% of health systems currently meeting the target and 23% expected to meet the goal only by 2019.
Did you know that health insurance companies alone lose a total of $72.5 billion annually due to […]
Across America a change in the healthcare landscape is marked by the emergence of both public and private Accountable Care Organizations (ACOs). In fact, the number of ACOs in the U.S. has grown from 64 in 2011 to 744 in 2015. Hoping to shift the focus of the healthcare industry from volume to value, ACOs focus on increasing quality, reducing, cost and improving the patient experience. This focus is called the Triple Aim.