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Payment reform redefines provider performance managementA health plan's approach to provider reimbursement is rooted in the need to move from traditional fee-for-service models to a payment model that accounts for providers adhering to best practices.
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Take steps to prepare for insurance exchangesInsurance exchanges will not exist in a vacuum; they will touch every part of the healthcare system and require substantial changes to the way payers do business.
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Review health risk assessment use under new GINA rulesFinancial incentives and penalties are no longer permitted when genetic information is requested on health risk assessments
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Kentucky co-op leverages outreach during open enrollmentNew members likely to have more chronic conditions
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States move forward with unique ACO models for MedicaidEarly efforts by states drive value with Medicaid ACOs, coordinated care.
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Elevating to ICD-10: It may be a great fit for healthcareThe World Health Organization's latest version of the International Classification of Diseases and Related Health Problems (ICD) will bring "the good, the bad, and the ugly" for nearly all who use this classification system. However, the biggest asset is that the latest version is much more detailed and organized than ICD-9.
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Elevating to ICD-10: It may be a great fit for healthcareThe World Health Organization's latest version of the International Classification of Diseases and Related Health Problems (ICD) will bring "the good, the bad, and the ugly" for nearly all who use this classification system. However, the biggest asset is that the latest version is much more detailed and organized than ICD-9.
Latest:
Elevating to ICD-10: It may be a great fit for healthcareThe World Health Organization's latest version of the International Classification of Diseases and Related Health Problems (ICD) will bring "the good, the bad, and the ugly" for nearly all who use this classification system. However, the biggest asset is that the latest version is much more detailed and organized than ICD-9.
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Exchanges would need local participationState-level insurance exchanges are more likely to thrive in the market by taking advantage of integration
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Green initiatives growing among healthcare facilitiesReducing water and electricity use can produce immediate savings for hospitals while recycling efforts pay off in the longrun
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How Artificial Intelligence Can Help Health Plans Manage Chronic ConditionsManaging members with chronic conditions is a complex, costly challenge for health plans. Using AI to combine real-time patient data and guideline-directed medical therapy can help.
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Consumer-driven pharmacy plans must focus on compliance and safetyA recent survey by the Employee Benefit Research Institute found that 70% of those enrolled in consumer-directed health plans (CDHP) say that they consider costs when deciding to see a doctor or filling a prescription as compared with fewer than 40% of those in a comprehensive plan. However, the survey also found that CDHP enrollees were twice as likely to avoid, skip or delay healthcare services.
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Consumers unwilling to change behavior to lower care costsWhile patients may complain about the rising cost of their healthcare, few of them appear willing to do much about it, according to a new survey.
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Begin obesity programs in early childhoodCustomize your obesity program for children, beginning as early as preschool
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Medicaid beneficiaries require improved case managementMedicaid beneficiaries require care management and case management services because there's a higher concentration of comorbid conditions and other significant issues in this population
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EHRs not sufficient for data liquidityAn EHR is one technology within the health IT portfolio, which also includes e-prescribing, clinical decision support, messaging and alerting, telehealth, consumer health information portals and other technologies
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EHRs not sufficient for data liquidityAn EHR is one technology within the health IT portfolio, which also includes e-prescribing, clinical decision support, messaging and alerting, telehealth, consumer health information portals and other technologies
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Use of telehealth could save billionsIf passed, the Medicare Telehealth Enhancement Act introduced earlier this year promises to greatly expand telehealth programs
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EHRs not sufficient for data liquidityAn EHR is one technology within the health IT portfolio, which also includes e-prescribing, clinical decision support, messaging and alerting, telehealth, consumer health information portals and other technologies
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Medical home model invests in primary careMCOs must evaluate outcomes of pilot programs before concluding that cost savings will follow quality trends
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Contraceptive coverage laws remain contentiousThe contraceptive mandate stoked the legal fire of religious groups.
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Young Adult Black Patients With Acute Myeloid Leukemia Patients Have Higher Death RateThe younger Black patients with acute myeloid leukemia (AML) had “alarmingly high” early death rates within the first 30 days of study enrollment, indicating possible delays in diagnosis and care, according to research results reported in the journal Blood Advances.
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MA star-rating policy must be improvedMedicare Advantage's star rating program includes overly ambitious benchmarks.
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Plans, NGA examine infant mortalityJapan and the UK outrank the United States in infant mortality measures
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Helping People Help Themselves: Driving Participation In Health Improvement ProgramsPrograms designed to improve health and lower health care costs only work if people use them. In an effort to increase participation, Health Management Corporation (HMC), a wholly owned subsidiary of WellPoint, Inc., researched what drives health plan members to enroll and engage in programs to improve their health.
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Best Practices in On-Site Wellness Series: Guidelines for Choosing a Health Screening and Flu Shot VendorToday, more companies are implementing wellness programs in order to improve the health and productivity of their employees, while at the same time reducing overall health care expenses. However, it is easy to think of health screenings as a commodity instead of what they truly are ? health care.
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Disease Management: a Look Back & AheadDisease management (DM) in the US can trace its roots back to the mid-1980s with the early work of California health plans and has come a long way since then. However, it wasn't until the mid 1990s that disease management became part of mainstream thinking, after several private for-profit companies introduced outsourced disease-management programs to large commercial health insurance providers. The "process/evolution" of DM in the United States has been and continues to be the major difference between disease management in the US and the UK...and other countries.
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The Missing Link in Healthcare Reform Why Healthy Living & Prevention Aren't Part of the Plan...But Need To BeAt this moment in history, we have a real opportunity to re-invent and revolutionize our entire healthcare system. However, current proposals are nothing more than a band-aid, missing the chance for true healthcare system reform. The proposed "fix" does very little to keep healthcare sustainable 10, 20 or 30 years from now.
