Payers & Providers

Health Care Reform – Why Are People So Worked Up?

Why did Americans work up for bringing health care reform? Statements like “Don’t touch my Medicare” indicate a poor understanding of America’s healthcare reform history. America is facing new challenges about medical care reform, and this system crisis has been reached to a dangerous level. Let’s take a look at how the healthcare system started

[ Read More ]

Guide to Navigating Quality Reporting For Healthcare Providers

Transitioning and succeeding in value-based care (VBC) is increasingly becoming the focus of many providers. Despite initial reservations, many providers are becoming ardent supporters of VBC payment models and are often the catalysts for change in their organizations. Traditionally, most providers were compensated under fee-for-service (FFS) arrangements (i.e., they were paid for services rendered, not

[ Read More ]

Executive Roadmap for Integrating Preventive Healthcare Services: Payers, Patients and Providers

According to the Polsinelli-TrBK Distress Indices Report, 20 hospitals have filed for bankruptcy since 2016. Looking ahead through 2019, medical cost trends remain stable but extremely high as healthcare costs continue to rise. HRI projects 2019’s medical cost trend to be 6%. This is consistent with the last five years, which have seen trends between 5.5% and

[ Read More ]

Big Data & Small Adjustments: 3 Quick Wins to Make a Positive Impact on Patient Payments

Over the past several years, “big data” has become an even bigger topic in our healthcare world. What has historically been a paper-based, analog industry now has access to large amounts of digital data. [1] Hospitals and health systems have digitized clinical and financial records, and pharmaceutical companies have created medical databases full of research

[ Read More ]

Health Plans Take Another Hit on Provider Directory Accuracy

CMS completed the first of three planned reviews of health plan Provider Directory Accuracy and the results were not good.  A few stats jump out: Nearly half of provider directory locations listed were inaccurate. (i.e. provider was not at the location listed, phone number was incorrect, or provider was not accepting new patients when the directory indicated

[ Read More ]

What Types Of Technologies Are Needed To Design Profit-driven Quality Improvement Programs?

Please check Part-I of this article, here. To improve overall profitability and bottom line, payers have a renewed focus on quality improvement programs. In today’s consumer-oriented environment, quality needs to be defined much more holistically. Soon, quality of care will not only be measured by the quality of an acute care episode, but also by

[ Read More ]