Reimbursement

September 07, 2022

Risk adjustment is a central feature of value-based care, but it can be abused. Natural language processing can make the process efficient and steer it clear of fraud and other problems.

July 29, 2022

The trend of primary care practices and businesses bearing risk has pitfalls. A trio of experts have suggestions for how they can be avoided, including taking steps to de-emphasizing diagnostic coding in the calculations that determine payment.

July 26, 2022

The plaintiffs in Kelley v. Becerra are arguing that the Affordable Care Act’s requirement that preventive services be covered without cost sharing is unconstitutional. In a factsheet published yesterday, the Urban Institute says that the ACA requirement has had an especially a large effect on women, partly because contraception is among the services covered by the no-cost-sharing rules that apply to private insurers.

June 27, 2022

Medicaid managed care organization (MCOs) may be better equipped to address social determinants of health (SDOH) and health equity than payers who use fee-for-service models because SDOH are central to many requirements for MCOs, including those pertaining to population health management, health equity and care coordination.

February 23, 2022

During the state of the industry webinar, AHIP experts reviewed policies and solutions to improve affordable access to care and shape healthcare in the post-pandemic world.

December 23, 2021

Despite calls for better integration of social care into healthcare delivery, the lack of adequate payment models has stymied efforts to improve health and reduce costs by paying for social interventions.

November 10, 2021

The high cost and limited clinical evidence for cell and gene therapies have led U.S. health plans and countries outside the United States to limit access.

January 13, 2021

UT Southwestern Accountable Care Network in Dallas led the pack in 2019 shared savings, garnering $50,626,938.

November 16, 2020

Community-based organizations should position themselves as groups with a deep, working knowledge of an area's geography, communities and residents.

November 16, 2020

Some employers would benefit if their older employees go on Medicare, and people in their 60s would have some safety net if they can't find a job with benefits. Provider revenues might take a hit because of lower Medicare reimbursement.