Health insurance claim denials cause many healthcare organizations to lose a significant amount of money each year. In fact, large health organizations frequently lose millions of dollars per year due to ineffective denial strategies.
Behavioral health integration in primary care has been one of the biggest healthcare trends in 2016 so far. From cracking the stigma surrounding mental health to paving the way for better access to behavioral health related services, integration is making waves in all facets of the healthcare continuum. 2016 will be an important year for Behavioral Health integration with everyone employers to payors recognizing the importance of treating mental health issues in a primary care setting.
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 & Medicaid Services is testing some new reimbursement and payment models for drugs, some of which mirror models currently used in the private sector. Medicare hopes working with providers, like many private payer networks, will lead to more efficiencies in prescriptions and eventually to lower costs.
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.