We are quickly heading to the value-based purchasing tipping point, according to the Vice President of Network Management at Health Partners Plans in Pennsylvania.
“While adoption rates are...
A large group of major healthcare payers and health systems are reporting that nearly half of their business rests in value-based payment arrangements.
The Health Care Transformation Task Force (Task...
Online Medicare Advantage provider directories are still not accurate, according to a recent CMS analysis of approximately one-third of Medicare Advantage Organizations (MAOs).
In its third round of...
The Department of Justice (DoJ) is shedding more light on its recent settlement with North Carolina-based Atrium Health over allegations the health system used its market power to create...
Atrium Health in North Carolina recently agreed to a settlement with the Department of Justice (DoJ) and the North Carolina Office of Attorney General that prohibits the health system from using...
Supporting primary care will bring value-based care results, asserts Humana’s Chief Medical Officer Roy Beveridge, MD.
Value-based arrangements between providers and payers have the lofty, yet...
“The overwhelming majority of hospitals and health systems are not the drivers in contract negotiations with commercial health insurers,” the American Hospital Association (AHA) recently...
Prior authorizations, or prior approvals, are strategies that payers use to control costs and ensure their members only receive medically necessary care. The cost-control process requires providers to...
Artificial intelligence (AI) in healthcare is influencing the next generation of radiology tools and helping to expand access to care in underserved or developing areas. The technology is supporting...
The nation’s largest non-profit health system, Ascension, and health payer Centene Corporation are teaming up to launch a Medicare Advantage plan in multiple markets, the organizations recently...
The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) are suing Anthem’s Blue Cross Blue Shield (BCBS) of Georgia over a new policy that allows the...
Many hospitals and health systems are bypassing the ultimate opportunity to gain greater control of the outcomes and costs of their patients. That opportunity is developing their own provider-sponsored...
Providers are in the business of keeping their patients healthy. But confusing payer contracts riddled with “legalese” and other complicated provisions can get in the way of improving...
A multi-disciplinary workgroup is calling for provider data standardization to ensure accurate provider information is available for connecting patients with providers, licensing providers, and paying...
Ensuring correct reimbursement in a timely manner is always at the top of a healthcare provider’s mind. But many provider organizations could be leaving money on the table with inefficient and infrequent payer contract...
Physicians are reporting that prior authorizations are negatively affecting patient care, a new American Medical Association (AMA) survey of 1,000 physicians showed.
Ninety-two percent of primary care...
The American Medical Association (AMA) and Anthem, Inc. recently announced that they will work together over the next year to streamline prior authorization requirements and improve the healthcare...
Over one-half (52 percent) of physicians reported that their patients faced coverage issues at least once a month because of provider directory accuracy challenges, revealed a new survey from the...
Six industry groups representing providers, payers, and pharmacists recently partnered to identify strategies to improve prior authorization processes, such as decreasing the number of providers...
Small differences in private payer performance on claims reimbursement and denials can challenge hospital revenue cycles, a new Crowe Horwath analysis of five major commercial managed care payers...
