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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.

Healthcare Groups to CMS: ACOs Need More Time in One-Sided Risk Models

October 17, 2018  |  Rajiv Leventhal, Managing Editor
article
Healthcare associations have written to CMS, urging the agency to reconsider its proposed regulation that would push ACOs more quickly into two-sided risk models.

CMS Announces 1,300 Participants for New BPCI Advanced Initiative

October 10, 2018  |  Rajiv Leventhal, Managing Editor
article
CMS has announced that nearly 1,300 hospitals and physician group practices have signed agreements with the federal agency to participate in the Administration’s BPCI Advanced model.

MGMA Survey: Medical Group Practices Cite Increased Burden from Regulatory Demands, EHRs

October 4, 2018  |  Rajiv Leventhal, Managing Editor
news
Nearly nine in 10 medical group practice leaders have said that the overall regulatory burden on their organization has increased over the past year, according to a new survey from the MGMA.

On the Road to Risk, Summit Medical Group is Driving in the Fast Lane

October 2, 2018  |  Rajiv Leventhal, Managing Editor
article
In a recent interview with Healthcare Informatics, Jeffrey Le Benger, M.D., outlined the progress and evolution of his organization and how it’s continuing to plunge ahead into the world of risk and value-based care.

On Capitol Hill, Healthcare Leaders Raise Concerns with CMS’ Proposed ACO Rule

September 17, 2018  |  Heather Landi, Associate Editor
article
During a House subcommittee hearing, healthcare leaders voiced concerns that CMS' proposed changes to the MSSP ACO program will impede progress in the transition to value-based care.

Physician Groups Ask Congress to Curtail Appropriate Use Criteria Law

September 13, 2018  |  David Raths, Contributing Editor
news
Although implementation of a law to require clinical decision support (CDS) use involving diagnostic imaging orders was pushed back from 2018 to 2020, medical organizations are asking Congress to consider modifications to reduce the burden on clinicians.

AMIA, MGMA, AMGA Offer Comments on CMS’ Latest E&M, Quality Payment Program Proposals

September 10, 2018  |  Rajiv Leventhal, Managing Editor
news
Leading health IT associations have varying sentiments and recommendations for CMS regarding its Physician Fee Schedule and the Quality Payment Program proposed rule.

Congressional Leaders Voice Concerns about Stability of ACOs with Proposed MSSP Changes

September 7, 2018  |  Heather Landi, Associate Editor
news
In a letter to CMS Administrator Seema Verma, leaders of the U.S. House of Representatives Ways and Means Committee weighed in on several recently proposed regulations from CMS related to burden reduction, including the agency’s overhaul of Medicare’s Accountable...

In the Emerging World of Risk-Based Contracting, Data Analytics Is a Foundational Necessity

September 7, 2018  |  Mark Hagland, Editor-in-Chief
article
With the emergence of more risk-based contracting, including two-sided risk, data analytics has now become fundamental to patient care organizations’ operational and financial success.

Top Ten Tech Trends 2018: Markets and Medicine—Where Do Physicians Land, in the Emerging World of U.S. Healthcare?

September 5, 2018  |  Mark Hagland, Editor-in-Chief
article
Even as the purchasers and payers of healthcare push hard on physicians to embrace value-based care delivery and payment, doctors remain conflicted and ambivalent about the new healthcare.

Announcing Next Gen ACO Results, CMS Administrator Verma Makes the Case for Moving ACOs to Two-Sided Risk

August 27, 2018  |  Heather Landi, Associate Editor
article
During a webinar, CMS Administrator Seema Verma touted the results of the Next Gen ACO model as evidence that ACOs succeed under two-sided risk as CMS proposes major changes to MSSP ACO program.

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.”

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.

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.

PODCAST: Policy Experts Dissect CMS’ “Modernizing Medicare” Proposed Rule

July 16, 2018  |  Rajiv Leventhal
article
Jeff Smith, vice president of public policy at AMIA, and Tom Lee, Ph.D., CEO and founder of Chicago based SA Ignite, a company that helps healthcare organizations with value-based reporting, weigh in on the different components of CMS' proposed rule

BREAKING: CMS Proposes Dramatic Changes with Aim to “Modernize Medicare and Restore Doctor-Patient Relationships”

July 12, 2018  |  Rajiv Leventhal
article
CMS today proposed changes that the agency believes will “fundamentally improve the nation’s healthcare system and help restore the doctor-patient relationship by empowering clinicians to use their EHRs to document clinically meaningful information.”

New Research Reveals MIPS Confusion Among Physicians

July 10, 2018  |  Rajiv Leventhal
article
A survey of internal medicine physicians has revealed low levels of familiarity with the Merit-based Incentive Payment System (MIPS), with some respondents also believing that MIPS requirements could lead to unintended consequences.

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.

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.

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.

At the Philadelphia HIT Summit, One Healthcare Leader Parses the Current State of Payer-Provider Convergence

May 24, 2018  |  Heather Landi
article
As the healthcare industry makes steady progress to value-based care models, one healthcare thought leader sees the commercial payer market playing a larger role, going forward, in pushing provider organizations into value-based care arrangements.

GAO: Just 4 of 37 CMMI Payment Models Have Met Goals around Cost, Quality

May 11, 2018  |  Rajiv Leventhal
news
CMMI, created to test new and cost-effective approaches for delivering and paying for healthcare, has partially met its goals, while just four out of the innovation center’s 37 alternative payment models have actually achieved lower spending and higher quality.

EXCLUSIVE: Substantial ACO Reforms Could be Forthcoming

May 9, 2018  |  Rajiv Leventhal
article
Healthcare Informatics has learned that a CMS rule is forthcoming that could shorten the duration ACOs can stay in one-sided risk models.

An HIT Expert Dives into the Details of CMS’ Proposed Hospital Payment Rule

April 30, 2018  |  Heather Landi
article
With ongoing discussion about the implications of CMS' proposed hospital payment rule, Jeff Smith, vice president of public policy at AMIA, dives into the details of the rule, including how CMS might be raising the interoperability stakes.

Study: System Functionality, Cost and Reporting Requirements Top Reasons for Switching EHRs

April 27, 2018  |  Heather Landi
news
System functionality and cost are the two largest deciding factors in healthcare providers’ decision to switch electronic health record (EHR) vendors, despite the significant cost associated with a new EHR purchase and implementation, according to a study...

Survey: Optimism for Health IT Startups in 2018, Skepticism for Amazon Healthcare Partnership

April 26, 2018  |  Heather Landi
news
Despite all the buzz about new entrants disrupting healthcare, the majority of healthcare stakeholders are dubious about the impact of the Amazon/Berkshire Hathaway/JP Morgan healthcare partnership and believe the effort will face substantial challenges,...

In Proposed MU Rebranding Rule, CMS Raises the Interoperability Stakes

April 26, 2018  |  Rajiv Leventhal and Heather Landi
article
As health IT observers and stakeholders have begun to unpack the 1,883-page CMS proposed rule on meaningful use rebranding, discussion has emerged on if the government will be forcing providers to participate in health information exchange activities.

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