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Alternative Payment Models

Reinventing Claims Management for the Value-Based Era

August 8, 2017  |  Carmen Deguzman Sessoms, FHFMA, AVP, Product Management, Change Healthcare
article
Provider claims management can no longer exist as a silo. With the rapid transformation from fee-for-service to value-based models, denial rates remain high despite advances in technology and automation. For providers to be effective, the revenue cycle...

Is HHS’ Proposal to Scale Back Mandatory Bundled Payments a Step Back from Value-Based Care? Many Healthcare Experts Say No

August 18, 2017  |  Heather Landi
article
Does HHS’s proposal to eliminate mandatory bundled payments signal that CMS is taking its foot off the accelerator in the movement to advanced alternative payment models? Some healthcare experts say no, as value-based payment models continue to drive forward.

CMS Provides More Details on Proposal to Eliminate Mandatory Bundled Payment Programs

August 16, 2017  |  Heather Landi
news
The Centers for Medicare and Medicaid (CMS) posted a press release Tuesday that provides more details regarding its proposal to change the Comprehensive Care for Joint Replacement Model and cancel the mandatory Episode Payment Models and Cardiac Rehabilitation...

HHS Proposes Eliminating or Changing Mandatory Bundled Payment Programs

August 14, 2017  |  Heather Landi
news
The Department of Health and Human Services (HHS) has proposed eliminating mandatory bundled payment in several areas of healthcare including cardiac care and joint replacement, according to a rule title posted last Thursday.

At the Health IT Summit-Philadelphia, a Frank Discussion of the Challenges around MACRA

August 10, 2017  |  Mark Hagland
article
At the Health IT Summit in Philadelphia, industry leaders engaged in a bracingly candid discussion of the complexities and challenges around the implementation of the MACRA law and around its requirements for providers

Survey: Medical Groups Find Complying with MIPS Extremely Burdensome

August 10, 2017  |  Heather Landi
news
Medical groups feel the pressure of regulatory burdens, with the vast majority of physician practices finding it difficult to comply with the Merit-Based Incentive Payment System (MIPS).

The Key to the Value-Based Transition: Marrying Clinical and Claims Data, Says One Expert

August 8, 2017  |  Rajiv Leventhal
article
Dr. Emad Rizk recently was interviewed by Healthcare Informatics about how healthcare organizations are progressing in their shift to value-based care, what the biggest challenges are, and how IT is playing a role.

Analysis: MSSP ACOs Should Take on Greater Financial Risk

August 3, 2017  |  Rajiv Leventhal
news
Accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) would have earned an additional net payments of $886 million in 2015 if they had assumed greater financial risk, according to a recent analysis from Washington, D.C...

80% of Healthcare Execs Confident in Future of Population Health Despite Political Uncertainty

August 1, 2017  |  Rajiv Leventhal
article
More than 80 percent of healthcare executives feel that the effort to repeal and replace the Affordable Care Act (ACA) has not caused them to pause or otherwise change their approach to population health management.

Where Are Health Systems Falling Short in Addressing Social Determinants of Health?

July 28, 2017  |  David Raths
commentary
Eighty percent of executives surveyed by the Deloitte Center for Health Solutions said social needs are a core part of their mission, but 72 percent said they don’t have sustainable funding to do it.

CMS Exploring Potential Behavioral Health Payment and Care Delivery Model

July 21, 2017  |  Heather Landi
news
The Center for Medicare & Medicaid Services (CMS) plans to hold a one-day summit in September to solicit feedback and ideas for a potential behavioral health model to improve access, quality and cost of care for beneficiaries with behavioral health conditions.

Report: Small Hospitals Lag Far Behind in Transition to Value-Driven Care

July 14, 2017  |  Heather Landi
news
There is a gap in capabilities and core competencies between large and small hospitals and health systems in the ongoing transition to value-driven care. What’s more, small organizations often lag far behind large ones in key components of the transition, putting...

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