Coverage decisions about new technologies, including access and cost considerations, are a major challenge for public and private payers.
We asked healthcare experts and analysts how the move to value-based care will affect prior authorizations. Here's what they said.
Consensus is building on the promise of genetic testing and other technological advances to help individualize testing, prevention and treatment for better outcomes.
Current methods used to measure hospital quality are fraught with problems that have large consequences for how hospitals are reimbursed by Medicare, according to a new study published in the March edition of The American Journal of Accountable Care.
As the Medicare program and the healthcare industry at large begins the transition from fee-for-service to value-based reimbursement models, health plans are responding by ramping up collaboration with providers to improve health outcomes, especially for medically-complex Medicare members.
A new, “next generation” accountable care organization model that encourages greater coordination between providers and beneficiaries has been launched by the U.S. Department of Health and Human Services.
In what is being called a first-of-its-kind joint effort, the Texas Medical Association and Blue Cross and Blue Shield of Texas are launching a resource initiative to assist independent physicians with providing accountable care.
More than 11 million UnitedHealthcare members are enrolled in accountable care organizations (ACOs), and the nation's top insurer plans to contract with 250 more ACOs in 2015.
In a shift from fee-for-service to value-based care, UnitedHealthcare has launched a pilot bundled payment model with the University of Texas MD Anderson Cancer Center for head and neck cancers.
Providers, owners and suppliers who owe Medicare money, have been convicted of felonies or have a history of billing abuse will be excluded from enrollment under new rules adopted by the Centers for Medicare and Medicaid Services (CMS).