Reinventing Claims Payment For A Value-Based World

Reinventing Claims Payment for a Value-Based World

  • June 6, 2017

Payers need to choose between automated payment and accurate automated payment 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…

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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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McKesson Entity Now Change Healthcare

McKesson Entity Now Change Healthcare

  • May 6, 2017

McKesson Technology Solutions and Change Healthcare have merged to create a new healthcare information technology company. The new Change Healthcare includes all of Change Healthcare's businesses and the majority of McKesson Technology Solutions, and will employ about 15,000 people. Read the article

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From Silos To Services For Value-Based Care

From Silos to Services for Value-Based Care

  • March 31, 2017

Morning Consult covered the evolution of HIT interoperability and how, despite industry advances, most systems aren't working together. The article reports on how interoperability facilitates value-based care and reimbursement, and why that's crucial to the future of HIT. 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

Health plans and hospitals see bundled payment as the fastest growing value-based payment model. They predict that the model will account for 17% of reimbursements in the next five years. But where do you begin? Start with this guide, "Four Steps to Develop, Implement, and Operationalize a Bundled Payment Strategy." The steps include analyzing data to identify episodes of interests, defining quality and savings targets, creating a transparent collaboration between payers and providers, and pulling it all together with a cloud-based claims analytics tool. Read now or download and read later    

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BPCI Bundles Don’t Fuel Volume Increases: Analysis

BPCI Bundles Don’t Fuel Volume Increases: Analysis

  • February 8, 2017

New research found no evidence that bundled payment models increase the volume of procedures. Researchers compared major lower joint replacement rates among participants in Medicare’s Bundled Payment for Care Improvement (BPCI) program with rates of all other Medicare hospitals from 2011 through 2015. They found procedures at BPCI hospitals increased by 2.5% compared to a 9.7% increase among other hospitals. Read the article

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From Silos To Services For Value-Based Care

From Silos to Services for Value-Based Care

  • September 19, 2016

Even though healthcare has spent decades automating processes and digitizing information, both remain remain largely locked in IT silos. There are impenetrable system boundaries between payers, providers, and vendors that reduce efficiency, increase costs, and resist automation. In other words, true interoperability is sorely lacking. From Silos to Services for Value-Based Care reviews the history of interoperability in healthcare and makes a case for how we can unlock the silos, bring information together, and align processes to improve clinical and financial outcomes. Read now or download and read later

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The Interoperability Imperative

The Interoperability Imperative

  • September 19, 2016

Interoperability in healthcare is not just about moving financial and clinical data between payer or provider or moving clinical data from one application to another. True interoperability allows enterprise applications to "talk" and collaborate in a smart, open, and agile manner. "The Interoperability Imperative" explains what this means; how and why interoperability is necessary to scale complex value-based reimbursement models; and how payers, providers, and vendors can get started. Read now or download and read later

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