Payers & Providers

HIPAA Privacy Rule Waiver and What it Means for Health Providers

The COVID-19 pandemic caused many changes in our society and the policies. U.S. healthcare system had to adapt to the new reality by restructuring several aspects of its operation, including the nation’s most crucial health privacy law, the Health Insurance Portability and Accountability Act (HIPAA). HIPAA was designed back in 1996 to improve the nation’s

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The Evolution of Provider-Led Health Plans in 2020 and Beyond

In a pre-pandemic world, providers and payers were proceeding with their usual pace toward value-based reimbursements. With a steadily-growing patient volume and broad health insurance coverage options, providers had the option of implementing value-based payment models with any number of insurance companies. Over time, providers began to explore the benefits of integration and in some

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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

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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

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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

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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

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