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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.

Report: 34 Percent of Healthcare Payments in 2017 Tied to APMs

October 22, 2018  |  Heather Landi, Associate Editor
news
One-third (34 percent) of total U.S. health care payments were tied to alternative payment models (APMs), such as shared savings/risk arrangements, bundled payments, or population-based reimbursements, in 2017, up from 23 percent in 2015, according to a report...

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.

Nemours Children’s Health’s New CEO: “The Most Exciting Time in Healthcare”

October 12, 2018  |  Mark Hagland
article
R. Lawrence Moss, M.D., who joined Nemours Children’s Health as CEO on Oct. 1, discusses the challenges and opportunities facing children’s hospitals and healthcare in the current environment

Heritage Medical Systems’ Voyage to Value—and How Physicians are Leading the Way

October 11, 2018  |  Rajiv Leventhal, Managing Editor
article
Mark Wagar, president of Heritage Physician Organizations, recently spoke with Healthcare Informatics about his organization’s value-based care journey, its ACO progress, and how physician culture can be changed.

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.

A Data-Driven Effort to Tackle Indiana’s COPD Problem

October 9, 2018  |  Rajiv Leventhal, Managing Editor
article
Although reduction in avoidable readmissions after COPD-related hospitalizations is a national objective, in one Indiana community it’s moved its way up to the very top of the healthcare priority list.

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.

Pew Report Digs Deep into Patient Matching Challenges, Recommendations

October 3, 2018  |  Rajiv Leventhal, Managing Editor
news
A new report from the Pew Charitable Trusts outlined several key themes related to patient matching, while also suggesting recommendations to improve matching and the infrastructure needed for more robust progress in the medium and long term.

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.

Survey: EHRs, Value-Based Care Causing Docs to Sour on Profession

October 1, 2018  |  Rajiv Leventhal, Managing Editor
news
Seven out of 10 physicians are unwilling to recommend their chosen profession to their children or other family members, with frustrations over EHRs and value-based care ranking as key reasons why.

What to Expect Next from CMS Regarding the Proposed ACO Rule

October 1, 2018  |  Lynn Barr, Industry Voice, CEO and Founder, Caravan Health
article
In the accountable care community, we’re all anticipating the potential impacts of the recently proposed Medicare Shared Savings Program (MSSP) ACO (accountable care organization) rule.

Climbing Up the Risk Ladder: How National ACO Has Built a Winning Value-Based Care Infrastructure

September 27, 2018  |  Rajiv Leventhal, Managing Editor
article
National ACO—headquartered in Beverly Hills, Calif., but with providers in multiple states—has progressed through the federal ACO ranks in a way that could set the path for others

NAACOS, AMA, Others Urge CMS to Reconsider MSSP Proposed Changes

September 21, 2018  |  Rajiv Leventhal, Managing Editor
news
NAACOS and eight other healthcare stakeholder groups have sent a letter to CMS, expressing concerns about the federal agency’s proposed changes to the Medicare Shared Savings Program.

Town Hall Ventures Close First Fund at $115 Million

September 20, 2018  |  David Raths, Contributing Editor
news
Town Hall Ventures, an investment firm built to address the healthcare challenges of the most vulnerable Americans, has closed its first fund at $115 million.

Survey: Physicians Sour on Value-Based Care Metrics, EHRs

September 19, 2018  |  Rajiv Leventhal, Managing Editor
news
More than 50 percent of U.S. physicians who receive value-based care compensation said they do not believe that the metrics the reimbursement is tied to improve the quality of care or reduce costs, according to a new survey.

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.

Humana’s CMO Speaks of the “Bold Goal” Embedded in the Company's Population Health Work

September 14, 2018  |  Heather Landi, Associate Editor
article
Roy Beveridge, M.D., Humana’s chief medical officer, shares his perspectives on the drive to value-based care, population health and addressing social determinants of health.

Leading ACO Group: CMS is Calculating ACO Savings the Wrong Way

September 11, 2018  |  Rajiv Leventhal, Managing Editor
article
The Medicare Shared Savings Program generated gross savings of $1.84 billion for Medicare from 2013 to 2015, nearly double the $954 million estimated by CMS, according to a new analysis.

Connecticut Receives $12.2M Grant to Build Statewide HIE

September 11, 2018  |  David Raths, Contributing Editor
news
The State of Connecticut will receive a $12.2 million grant to support ongoing work that will establish Connecticut’s first statewide health information exchange.

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.

Putting Social Determinants of Health Data into Action

September 10, 2018  |  Heather Landi, Associate Editor
article
Leading hospitals, medical groups, and health systems, as well as ACOs and health insurers are moving forward to address social factors impacting health with a number of different approaches.

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.

CPT Codes Updated to Reflect HIT Advancements

September 6, 2018  |  Rajiv Leventhal, Managing Editor
news
The American Medical Association (AMA) announced the release of the 2019 Current Procedural Terminology (CPT) code set, with changes reflecting new technological shifts in the industry.

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.

Top Ten Tech Trends 2018: A Social Determinants of Health Technology Market is Slowly Emerging

September 4, 2018  |  Heather Landi, Associate Editor
article
The IT market for social determinants of health data is currently a nascent field with many providers using homegrown solutions, but adoption of SDoH technology is expected to grow quickly.

Is it Fair to Question CMS’ Agenda for Releasing ACO Results?

September 4, 2018  |  Rajiv Leventhal, Managing Editor
commentary
There is much debate on how one-sided risk ACOs are performing as new CMS data has been released

Top Ten Tech Trends 2018: Are the Lines Between Provider and Payer Organizations Beginning to Blur? To Some, That Would be Progress

September 4, 2018  |  Mark Hagland, Editor-in-Chief
article
As physician-based and hospital-based organizations plunge further into risk-based contracting, managing the contracts and the processes is turning out to be highly challenging for everyone.

Industry Groups Urge CMS to Reform Stark Laws, HHS Considers Reforming Anti-Kickback Statute

August 31, 2018  |  Heather Landi, Associate Editor
news
On June 25, the Centers for Medicare & Medicaid Services (CMS) issued a request for information (RFI) for public input on how to address any undue regulatory impact and burden of the physician self-referral law, also known as the Stark Law.

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