Bundles In A Bind? Cardiac Care Models Expected To Prevail

Bundles in a Bind? Cardiac Care Models Expected to Prevail

  • June 30, 2017

Cardiovascular Business reports the Centers for Medicare & Medicaid Services has delayed the launch of a new episode payment model affecting three types of cardiac care, from July 1 to the beginning of 2018. But that doesn’t mean providers and hospitals should ease back on bundles’ preparations. Read the article

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Reinventing Claims Payment For A Value-Based World

Reinventing Claims Payment for a Value-Based World

  • June 8, 2017

The health care industry’s claims payment system is frustrating, inefficient, and prone to errors, according to a new Op-Ed in Morning Consult. But Amy Larsson says one way to overcome these challenges is to start automating disparate payment systems to reduce manual interventions and thus the errors they might introduce. Read the article

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Reinventing Claims Payment For A Value-Based World

Reinventing Claims Payment for a Value-Based World

  • June 6, 2017

By Amy Larsson RN, BSN, MBA The U.S. healthcare industry’s claims-payment system is frustrating to providers, payers, and patients alike. Inefficiency and a systemwide tendency for error wastes precious resources, worsens miscommunication and mistrust among all stakeholders, and inhibits the ability to transition to value-based approaches that achieve better outcomes. We need to rethink our industry’s disjointed and siloed approach in order to solve a very integrated problem. Despite billions invested in achieving efficient claims payment, more than 7% of claims are not paid correctly the first time, the second time, and sometimes even the third time.¹ The remediation process…

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In The End, It Will Be Episode Payment

In the End, It Will be Episode Payment

  • May 10, 2017

Horizon Blue Cross Blue Shield of New Jersey is leading the way in transforming cancer treatment reimbursement models to value-based care. Managed Care magazine reports that in 2014, the insurer piloted an episode-of-care program for breast cancer, and it has been successful enough that Horizon will be expanding to treat other cancer types the same way in the near future. Read the article

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Four Steps To Develop, Implement, And Operationalize A Bundled Payment Strategy

Four Steps to Develop, Implement, and Operationalize a Bundled Payment Strategy

  • February 17, 2017

By Andrei Gonzales, M.D. In the continuing effort to increase quality and decrease costs, health plans and providers are shifting from volume-based care (fee for service) to a value-based reimbursement structure (fee for value). Value-based reimbursement promises benefits to patients, providers, and health plans, as it encourages delivery of high quality care at the lowest cost, largely by improving clinical and administrative efficiency.¹ This paradigm shift to value-based reimbursement creates increasingly complex reimbursement scenarios for health plans. According to a “Journey to Value” study Change Healthcare commissioned, an overwhelming 97% of health plans and 91% of hospitals are now deploying…

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From Silos To Services For Value-Based Care

From Silos to Services for Value-Based Care

  • September 19, 2016

A bundled payment program built by hand 25 years ago is still delivering lessons for HIT today By Amy Larsson The evolution of healthcare IT systems seen by industry visionaries sounds great. Siloed clinical and insurance systems get connected and can work as one. Information-rich processes flow smoothly and securely over connected services that span care settings, providers, and payers. We gain leaps in efficiency, quality, and accuracy of care coordination, delivery, and payment systems. And as healthcare evolves in its journey to value, we snap clinical and payment services together like the related pieces of the healthcare puzzle that…

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The Interoperability Imperative

The Interoperability Imperative

  • September 19, 2016

How interoperability unlocks silos in enterprise applications and connects the business logic needed to support value-based reimbursement By Michael Wood Interoperability is about more than just moving data from one application to another. It’s about easily and seamlessly capitalizing on the business logic that is locked within separate—and often siloed—applications to create new capabilities that can solve business problems in a unique way. Today, interoperability must occur both within the four walls of a payer or provider’s IT infrastructure as well as within or between on-premise, off-premise, cloud, hybrid, and other hosting approaches in a manner that appears to be…

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