How To Engage Providers Differently To Satisfy The New Healthcare Consumer

How to Engage Providers Differently to Satisfy the New Healthcare Consumer

  • December 21, 2015

Transforming provider relationships can be the key to engaging consumers By Dianne Wagner and Carolyn J. Wukitch U.S. health plans today operate in a world of rising expectations. They must work to contain increasing healthcare costs, while at the same time cater more to consumers. Members are the ultimate users of healthcare and health plans can no longer seek to solely satisfy the demands of employers. Health plans are redesigning their networks in search of value—finding the providers who deliver the best quality care, preventing health problems before they occur, and doing so efficiently and cost-effectively. In addition to the…

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Five Ways To Improve Medi-Cal Claims Processing

Five Ways to Improve Medi-Cal Claims Processing

  • September 23, 2015

Roughly one in three California residents— approximately 12 million people—are enrolled in Medi-Cal, the state’s publicly funded Medicaid program. To put this in perspective, California has 12% of the U.S. population, and yet accounts for 17% of the nation’s Medicaid enrollment. And the enrollment is growing—with 2.7 million people added since federal healthcare reform was enacted. Given the large percentage of revenue that Medi-Cal claims constitute for California hospitals, efficient and accurate Medi-Cal claims processing is a high priority for healthcare providers. But in reality, many providers find that Medi-Cal claims can be difficult to manage. The root causes of…

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The Top 10 Things Payers And Providers Can Do Today To Start Aligning With VBR Tomorrow

The Top 10 Things Payers and Providers Can Do Today to Start Aligning with VBR Tomorrow

  • March 11, 2015

CMS says VBR is now an imperative. What can you do to make the grade? By Carolyn J. Wukitch and Andrei Gonzales, M.D. The stakes have just been raised for payers and providers who are besieged by a rapidly changing market. In an announcement that reverberated throughout healthcare, HHS Secretary Sylvia M. Burwell introduced an initiative to make alternative payment the standard for 50% of Medicare reimbursement by 2018. That’s the first time HHS established goals for alternative payment models for Medicare. HHS wants 30% of fee-for-service payments to be tied to quality or value through ACOs, bundled payment, or…

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How We Can Make Healthcare Payment And Delivery Reform Work

How We Can Make Healthcare Payment and Delivery Reform Work

  • January 9, 2015

Powerful incentives and inertia remain intact, limiting stakeholders’ willingness to experiment with the range of innovative reimbursement models that promise to make the effort and cost of reform worthwhile. The result: growing agreement that transition to a system that fosters experimentation with mixed reimbursement schemes is required to ease away from the existing FFS model and the entrenched processes and technologies that are already in place. It’s said that imminent execution concentrates the mind. It could also be said that the looming specter of draconian cuts to healthcare, and their financial impact on stakeholders, are driving innovation in payment and…

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