Can Utilization Management Work In A Value-Based World?

Can Utilization Management Work in a Value-Based World?

  • August 5, 2014

Beauty is in the eye of the beholder. And solutions to healthcare’s problems are in the eye of the stakeholder. Payers see the world one way, providers another, and patients still another. Finding solutions that balance stakeholders’ concerns isn’t easy. But it’s not impossible, if you bring the varying points of view together. I've been privileged to work with all stakeholders—payers, providers, and patients—and have heard (and hear) their problems, anxieties, and concerns. It’s from this vantage point that I've been wrestling with the problem of utilization management in a world that’s moving rapidly to value-based models. Today, prior authorization…

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HISTalk Interviews Linda Reed, CIO, Atlantic Health

HISTalk Interviews Linda Reed, CIO, Atlantic Health

  • July 28, 2014

In an eye-opening interview with HISTalk, Linda Reed, CIO of Atlantic Health, talks about her IT challenges, where she's putting her energy now, and what direction Atlantic Health's IT will be heading in the future. She addresses mobile app technology, the big strategic issues that need fixing, technologies for ACOs, population health management, and analytics. Everything, she says, is moving towards retail medicine. "We have to think about fast access, customer service, the customer’s always right — those things that you’ve traditionally heard about retail environments. We have to stop thinking about healthcare as a civil servant-type environment where you call and you…

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ICD-10 Testing At Kaiser Permanente

ICD-10 Testing at Kaiser Permanente

  • July 21, 2014

In ICD-10 Monitor, a Kaiser Permanente exec details how the organization accomplished the momentous task of testing for ICD-10 readiness, which included sending approximately 100 claims to the Centers for Medicare & Medicaid Services (CMS) via RelayHealth Financial during the ICD-10 Testing Week. Read the details here

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The State Of Value-Based Reimbursement And The Transition From Volume To Value In 2014

The State of Value-Based Reimbursement and the Transition from Volume to Value in 2014

  • June 11, 2014

How fast are payers and providers adopting new value-based payment models? According to the first industry study of its kind, more than two-thirds of payments are expected to be based on value measurements by 2020. Remarkably, 90% of payers and 81% of providers are already using some mix of value-based reimbursement and fee-for-service, according to the new report, The State of Value-Based Reimbursement and the Transition from Volume to Value in 2014. Read now or download and read later  

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McKesson Research Reveals the State of Healthcare’s Transformation from Volume to Value

  • June 11, 2014

DOWNLOAD and share the white paper now Healthcare is moving rapidly to incorporate measures of value into payment models, with more than two-thirds of payments expected to be based on value measurement in five years, up from just one third today. That’s just one of the compelling findings from our new report, The 2014 State of Value-Based Reimbursement, an independent research study of 464 payers and providers conducted by ORC International and released this week at AHIP’s Institute 2014 conference in Seattle, Wash. In the study’s executive summary, McKesson’s Medical Director David Nace, M.D., says these results point to a sea change…

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McKesson Research Reveals The State Of Healthcare’s Transformation From Volume To Value

McKesson Research Reveals the State of Healthcare’s Transformation from Volume to Value

  • June 11, 2014

Healthcare is moving rapidly to incorporate measures of value into payment models, with more than two-thirds of payments expected to be based on value measurement in five years, up from just one third today. That’s just one of the compelling findings from our new report, The 2014 State of Value-Based Reimbursement, an independent research study of 464 payers and providers conducted by ORC International and released this week at AHIP’s Institute 2014 conference in Seattle, Wash. In the study’s executive summary, McKesson’s Medical Director David Nace, M.D., says these results point to a sea change in healthcare reimbursements, a change in…

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AHIP’s Institute 2014: The Connective Thread

AHIP’s Institute 2014: The Connective Thread

  • May 28, 2014

How can we juggle a multitude of siloed systems and IT processes? How can we effectively diversify in a rapidly changing market? How can we make a positive impact on care decisions before care is delivered?   At McKesson, we’ve begun a new conversation about today’s complex healthcare reimbursement landscape - that starts with the challenges our customers face as they lead their organizations and the entire industry towards a more collaborative and integrated future. Join us to discuss some of the big questions about changing consumers, shifting regulations, and new methodologies at AHIP’s Institute in Seattle on June 11-13.…

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The Key To HIX Success: Network Flexibility

The Key to HIX Success: Network Flexibility

  • May 19, 2014

For today’s payers, “success will require staying competitive on price, network quality, and access,” writes Michael Flanagan, vice president, product management, McKesson Health Solutions, in Managed Care Magazine. "Payers must be agile enough to adjust network strategies on the fly as they learn more about newly enrolled populations. They need the ability to administer more complex product designs, care delivery and reimbursement initiatives quickly and efficiently." In his recent byline, Flanagan offers a template for health plans to drive their activity on the health insurance exchanges. These areas include strategic review, network requirements, contract modeling and reimbursement configuration with key…

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