From Silos To Services For Value-Based Care

From Silos to Services for Value-Based Care

  • January 1, 2017

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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Five Ways To Improve Medi-Cal Claims Processing

Five Ways to Improve Medi-Cal Claims Processing

  • January 1, 2017

About 12 million Californians are enrolled in Medi-Cal, the state’s Medicaid program. But many providers find that Medi-Cal claims are challenging to manage, leading to claim denials and lost or delayed revenue. The good news: RelayHealth Financial’s research revealed five actions hospitals can take to improve Medi-Cal claim processing, speed reimbursement, and reduce denial rates. Learn more about these five actions and how to implement them. Read now or download and read later

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Credible, Defensible Estimates

Credible, Defensible Estimates

  • January 1, 2017

Believe it or not, patients actually notice and care about the billing process. A recent survey found the higher a patient's satisfaction with the billing process was, the higher their overall satisfaction with the hospital and the clinical treatment received. Credible, Defensible Estimates explains why hospitals should help patients gain a realistic expectation about their financial responsibility up front, and how to make that happen on a consistent, reliable basis. The white paper also describes RelayHealth's Estimation Maturity Model (EMM) for creating estimates. Read now or download and read later

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Ten Steps To Reduce Denials, Win More  Appeals, And Improve Hospital Performance

Ten Steps to Reduce Denials, Win More Appeals, and Improve Hospital Performance

  • January 1, 2017

Providers face tremendous pressure to reduce denials. Although many issues can lead to denials, there’s one area that denial management programs can easily overlook: issues related to medical necessity. This white paper focuses on 10 gaps that can cause medical necessity denials and how to address them, from beefing up emergency department case management to improving level of care management. Read now or download and read later

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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

  • January 1, 2017

CMS set a goal of having value-based payments account for 50% of Medicare reimbursement by 2018. It's equally ambitious and daunting for many payers. But in this new white paper, The Top 10 Things Payers and Providers Can Do Today to Start Aligning with VBR Tomorrow, McKesson offers a proven 10-step plan that can help payers and providers work together to accelerate their journey to value and improve their odds of achieving these regulatory goals. Read now or download and read letter

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Journey To Value: The State Of Value-Based Reimbursement In 2016

Journey to Value: The State of Value-Based Reimbursement in 2016

  • January 1, 2017

There's no turning back from value-based care and value-based reimbursement. Payers are 58% along the continuum to VBR, up from 48% in 2014. And Providers are now 50% down the road to value. That's according to a national study of 465 payers and hospitals conducted by ORC International and commissioned by McKesson. Yet despite tremendous growth in capitation/global payments, pay for performance, and episode of care/bundled payments, many payers and providers still face obstacles in the transition to value-based care. See where healthcare stands in its journey to value and what it means for the industry in Journey to Value: The State…

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The Interoperability Imperative

The Interoperability Imperative

  • January 1, 2017

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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CMS To Continue Use Of InterQual Criteria

CMS to Continue Use of InterQual Criteria

  • December 19, 2016

Today McKesson Health Solutions announced that the Centers for Medicare & Medicaid Services (CMS) will continue their long-term use of InterQual Criteria for Medicare services auditing programs. Extending a 17-year relationship, CMS will continue to benefit from InterQual's evidence-based clinical decision support to help better manage patients as the industry transitions to value-based care. Read the news release

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Put Prior-Auth On The Fast-Track

Put Prior-Auth on the Fast-Track

  • December 15, 2016

Everyone who thinks prior-authorization is a fast, efficient process, please raise your hand. No raised hands? No surprise. That’s because the prior auth process has been on the slow track for years, powered by paper, faxing, siloed software, and phone calls. Now payers can give provider networks a fast-track option for prior auth, where getting an authorization is as easy as requesting it through the payer’s care management portal. Payers like it because it reduces costs by freeing staff to tackle other things. Providers like it because it helps speed quality care. In fact, the only people who don’t like…

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