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Reinventing Utilization Management to Bring Value to the Point of Care

February 21, 2018  |  Nilo Mehrabian Vice President, Product Management, Decision Support, Change Healthcare
article
How an automated exception-based approach can make UM more efficient and effective.

Assessing CMS’s Risky Move on Risk: Has Seema Verma Pushed MSSP ACOs Into Uncharted Territory?

August 13, 2018  |  Mark Hagland, Editor-in-Chief
commentary
Will Seema Verma’s August 9 announcement of CMS’s new “Pathways to Success” proposal light a fire under the MSSP ACOs, or will it cause provider organizations to flee? CMS officials are taking a risky gamble—with no clear outcome

CMS’ MSSP Proposed Changes Slammed by Leading ACO Organization

August 10, 2018  |  Rajiv Leventhal
article
The National Association of ACOs called CMS’ proposals to redo the MSSP “misguided,” noting that the changes, if finalized, “will upend the ACO movement by creating havoc with a significant overhaul introducing many untested and troubling policies.”

BREAKING: CMS Proposes Sweeping Changes to MSSP ACO Program

August 9, 2018  |  Rajiv Leventhal and Heather Landi
article
The Centers for Medicare & Medicaid Services (CMS) is proposing a new direction for ACOs (accountable care organizations) in the Medicare Shared Savings Program (MSSP), with the goal to push these organizations into two-sided risk models.

A Pioneering M.D. Leader Shares Insights on Successfully Navigating the Massachusetts Healthcare Market

August 9, 2018  |  Rajiv Leventhal
article
At the Boston Health IT Summit, the veteran healthcare expert dropped in to give attendees an inside look at how her organization has achieved value-based care success

At the Health IT Summit in Boston, One ACO’s Data-Facilitated Journey Into Value

August 7, 2018  |  Mark Hagland
article
What does it mean for an organization to pursue a data-facilitated journey into value-based care? Bill Gillis, CIO of the Beth Israel Deaconess Care Organization, shared his learnings and perspectives on that subject, at the Health IT Summit in Boston

BREAKING: CMS Finalizes “Promoting Interoperability” Rule

August 2, 2018  |  Rajiv Leventhal
article
Just three months after issuing a proposal, the Centers for Medicare & Medicaid Services (CMS) has finalized a rule late this afternoon that will overhaul the meaningful use program with a core emphasis on advancing health data exchange among providers.

Can Blue Cross of North Carolina Help to Reshape Its State’s Healthcare Landscape?

July 31, 2018  |  Mark Hagland
commentary
Remarks made by Patrick Conway, M.D. this spring point to some of the opportunities—and profound challenges—facing the shift towards a value-based healthcare system in North Carolina—and the challenges facing health insurers attempting to stimulate that change

Glancing at the Boston Healthcare Provider Market: Consolidation and Physicians

July 28, 2018  |  Mark Hagland
article
Barbara Spivak, M.D., CEO of MACIPA, an area IPA, shares her perspectives on the prospects and context of a proposed mega-merger of Boston-area hospitals—and the impact of ongoing consolidation on physicians

Pondering the Psychology of Incentives in Bundled-Payment Contracts

July 27, 2018  |  Mark Hagland
commentary
Healthcare policy researchers, in an op-ed piece in the Health Affairs Blog, ponder the differences between prospectively and retrospectively based bundled payment incentives to providers—at a moment of early experimentation

In Virginia, Centra Health Surges Ahead in its IT-Based Push to Value

July 25, 2018  |  Rajiv Leventhal
article
Two of the health system’s executive leaders recently spoke with Healthcare Informatics about Centra Health’s value-based care journey and how IT is playing a key role.

Has the Value-Based Care Train Stalled?

July 19, 2018  |  Rajiv Leventhal
commentary
When pondering the question of if the value-based care train has stalled, the answer will depend on which side of the healthcare stakeholder table you are asking—payers or providers.

Could Last Week’s Proposed-Rule Release Represent an Inflection Point for CMS and for Value-Based Federal Payment?

July 18, 2018  |  Mark Hagland
commentary
CMS’s release of a proposed rule that will impact a range of issues, from physician payment to quality measures, has unleashed a range of reactions from industry leaders—could this prove to be an inflection point?

Healthcare Leaders React to CMS’ 2019 QPP Proposed Rule and E&M Coding Changes

July 18, 2018  |  Heather Landi
article
Some health IT industry groups have voiced concerns that the CMS proposals, specifically in its proposed rule for the third year of the Quality Payment Program, will undermine efforts to move Medicare provider payment to value.

Aligning Incentives in the Forward Evolution Around Value-Based Payment: Major Obstacles Cited

July 16, 2018  |  Mark Hagland
commentary
The implications of a recent HFMA-sponsored analysis of value-based healthcare are many—and challenging, for the pioneers of VBP in new payment models in U.S. healthcare

The Rocky Path to Value for Medicaid Programs—and HIT’s Key Role in Making It All Work

July 11, 2018  |  Mark Hagland
commentary
Medical researchers share some insights on the broad range of challenges facing the pioneers attempting to move Medicaid towards value-based payment incentives, including around the key role that HIT and data analytics will play in success

CMS Offers Demonstration to Waive MIPS Requirements for Some Clinicians

July 2, 2018  |  Rajiv Leventhal
news
CMS is advancing the Medicare Advantage Qualifying Payment Arrangement Incentive Demonstration, which, when approved and adopted, would waive Merit-Based Incentive Payment System (MIPS) requirements for some clinicians.

Can We Get to the Next Level When It Comes to Quality Measures for the Care of Patients with Complex Needs?

June 27, 2018  |  Mark Hagland
commentary
A commentary posted online on Tuesday on the Health Affairs website makes important points about the landscape around the measurement of quality in the context of care for patients with complex needs

Analysis: Early Years of VBP Models Show Limited Impact on Reducing Cost of Care

June 25, 2018  |  Heather Landi
news
The penetration of population-based value-based payment models is not yet having an impact on curbing growth in total cost of care, according to a new analysis by the Healthcare Financial Management Association (HFMA), Leavitt Partners and McManis Consulting.

Value-Based Care is Bending the Cost Curve, Report Finds

June 18, 2018  |  Rajiv Leventhal
news
Value-based care is bending the healthcare cost curve, reducing unnecessary medical costs by nearly 6 percent on average while also improving care quality and patient engagement, according to new research from Nashville-based Change Healthcare.

Researchers Find a Bundle of Complications Around Bundled Payment Outcomes

June 14, 2018  |  Mark Hagland
commentary
An article published in the current issue of Health Affairs uncovers some of the complexities of mandatory and voluntary bundled payment programs, and some of the implications for their policy and payment future

The Strategic and Strategic-IT Challenges Around Risk: Premier Execs Share Their Thoughts

June 11, 2018  |  Mark Hagland
article
Joe Damore, Shawn Griffin, M.D., and Mark Hiller, senior executives at Premier Inc., share their perspectives on the strategic-organizational and strategic-IT challenges involved, as patient care organizations begin to move into risk-based contracting

Editor's Notes: When Will We Be Able to Nail the “Golden Spike” in the Foundation of the New Healthcare?

June 8, 2018  |  Mark Hagland
commentary
Some of the challenges of the present moment in U.S. healthcare, as our healthcare system struggles forward in its journey into value-based care delivery and payment, brought to my mind the construction of the First Transcontinental Railroad in the 19th Century.

Up-and-Comers 2018: Aledade and Arcadia

June 5, 2018  |  David Raths
article
Each year, to accompany our Healthcare Informatics 100 list, we profile fast-growing companies that could very well make the list in the future. Inside are write-ups of the first two companies that made this year’s Up-and-Comers rendition.

The Push Towards Value-Based Care Is Forcing the HIT Vendor Market Forward

June 4, 2018  |  Heather Landi
article
For a Market Scan report in our Second Quarter issue, we look at how the policy and payment landscape is impacting the healthcare technology vendor market. Are technology companies meeting providers’ needs to be successful in a value-based care world?

CMS Hits MIPS Participation Goal for Year One

June 4, 2018  |  Rajiv Leventhal
news
According to CMS Administrator Seema Verma, 91 percent of all Merit-based Incentive Payment System (MIPS)-eligible clinicians participated in the first year of the Quality Payment Program (QPP), exceeding the agency’s internal goal.

Value-Based Care’s Landscape Tilt

May 31, 2018  |  Mark Hagland
article
As the healthcare landscape shifts, U.S. healthcare leaders are learning valuable lessons in how to prepare broadly to take on financial risk in contracts with the public and private purchasers and payers of healthcare, and how to engage and align physicians.

In the New Healthcare, Payers and Providers Look to Redefine Quality

May 30, 2018  |  Rajiv Leventhal
article
The pressure is mounting on providers to deliver better outcomes. But moving forward, federal leaders must strike a balance between being able to measure outcomes while not overburdening patient caregivers even more.

Karen DeSalvo Joins MedPAC as New Member

May 30, 2018  |  Rajiv Leventhal
news
Five new members have been added to the Medicare Payment Advisory Commission (MedPAC), including former National Coordinator for Health IT, Karen DeSalvo, M.D., the Government Accountability Office (GAO) announced.

A Cloudy HIT Policy Picture is Beginning to Clear Up

May 29, 2018  |  Rajiv Leventhal
article
At this time last year, healthcare stakeholders were filled with uncertainty, as the future of healthcare policy remained very much in limbo. But in the past several months, an air of stability has presented itself.

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