Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value Based Care

Hospital Execs, Payers Face Similar Value-Based Purchasing Barriers

February 16, 2018 - Payers and hospital finance executives agree that health IT inadequacies and insufficient physician buy-in are top barriers to value-based purchasing adoption, two recent surveys revealed. The Healthcare Financial Management Association’s (HFMA) Value-Based Payment Readiness survey, sponsored by Humana, revealed that poor data access and the inability to collect and manage data were...


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Healthcare Supply Chain Management Market to Reach $2.3B by 2022

by Jacqueline Belliveau

Growing at a compound annual growth rate (CAGR) of 8.4 percent, researchers projected the global healthcare supply chain management market to reach $2.31 billion by 2022, a recent Markets and Markets report showed. The value of the healthcare...

Reducing Low-Value Care Key to Value-Based Reimbursement Success

by Jacqueline Belliveau

Value-based reimbursement success hinges on decreasing low-value care across patient populations, explained Scott Weingarten, MD, MPH, Senior Vice President and Chief Clinical Transformation Officer at Cedars-Sinai Medical Center. While hospitals...

AMGA: Link Spending, Quality Performance for True Value-Based Care

by Jacqueline Belliveau

In response to a Request for Information from the Assistant Secretary for Planning and Evaluation (ASPE), AMGA recently called on CMS to “define value in a meaningful way” to ensure value-based care models incentivize providers to...

72% of Clinicians See No Adjustment Under Value Modifier in 2018

by Jacqueline Belliveau

An overwhelming majority of clinicians who participated in the final year of the Value-Based Payment Modifier (Value Modifier) program will receive neutral payment adjustments in 2018, according to new CMS data. Out of over 1.1 million eligible...

AMGA: Align Medicare Advantage, APMs to Promote Value-Based Care

by Jacqueline Belliveau

If CMS moves forward with relaxing Medicare Advantage benefit requirements, then the federal agency should offer the same flexibilities to providers and beneficiaries in Medicare Part B alternative payment models, such as accountable care organizations...

Mandatory Bundled Payments Drive Value-Based Care, Docs Argue

by Jacqueline Belliveau

The recent decision from CMS to cancel two mandatory bundled payments programs slated to launch in 2018 was a “step in the wrong direction for pursuing a healthcare system that focuses on value and not volume,” three physicians argued...

3 Strategies to Reduce Hospital Readmission Rates, Costs

by Jacqueline Belliveau

Providers understand that high hospital readmission rates spell trouble for patient outcomes. But excessive rates may also threaten a hospital's financial health, especially in a value-based reimbursement environment. Readmissions are...

Vermont ACO Receives $620M to Lead Healthcare Reform Efforts

by Jacqueline Belliveau

Vermont’s healthcare reform group, Green Mountain Care Board, recently approved a budget of $620 million for OneCare Vermont, an accountable care organization (ACO) working with Medicare, Medicaid, and private payers, local news sources...

Nearly 71% of Practice Revenue Under Fee-For-Service in 2016

by Jacqueline Belliveau

Fee-for-service was still the dominant source of medical practice revenue in 2016, the American Medical Association (AMA) recently reported. Almost 84 percent of physicians stated that their practice received fee-for-service revenue in 2016....

Key Capabilities for Value-Based Reimbursement Models

by Jacqueline Belliveau

Rising healthcare costs, shrinking reimbursement rates, and federal policies are driving hospitals and health systems to adopt value-based reimbursement, according to a new American Hospital Association (AHA) report. But the models are not one-size-fits-all...

High-Value Culture, Population Health Programs Key to ACO Success

by Jacqueline Belliveau

Creating a high-value culture, engaging in proactive population health management, and implementing an infrastructure that promotes continuous performance improvement were key characteristics of 11 successful accountable care organizations (ACOs)...

Collaboration Key to Independent Physicians in Value-Based Care

by Kyle Murphy, PhD

At first glance, value-based care models appear to work against independent physicians. The risk-based arrangement requires a coordination of services across care continuum — primarily between primary care physicians and specialists but...

Family Physicians Slowly Embracing Value-Based Reimbursement

by Jacqueline Belliveau

Slightly more family physicians are actively pursuing value-based reimbursement opportunities compared to two years ago despite persistent barriers, Humana and the American Academy of Family Physicians (AAFP) recently announced. The survey of...

Six Characteristics of High-Value Primary Care Practices

by Jacqueline Belliveau

High-value primary care practices that achieved exceptional care quality at reduced costs shared six attributes centered around risk-stratified care management, mindful specialist selections, and care coordination, a new study in the Annals of...

Value-Based Contracts Rely on Patient Attribution, Data Sharing

by Jacqueline Belliveau

CMS aims to tie 90 percent of Medicare fee-for-service payments to quality by the end of 2018, with one-half of those payments to be paid under a value-based contract with some degree of financial risk. With ambitious goals from the federal government,...

Addressing Quadruple Aim, Physician Burnout Key to Risk Success

by Jacqueline Belliveau

From capturing patient risk to meeting quality measures, providers face a daunting list of items needed to achieve the Triple Aim of value-based care. But healthcare organizations will not see lasting cost savings and care quality improvements...

Post-Acute Care Orgs Lack IT, Data Analytics for Value-Based Care

by Jacqueline Belliveau

Value-based care hinges on data analytics and provider communication across the care continuum. However, post-acute care providers do not have the health IT infrastructure or communication workflows in place to support value-based reimbursement...

40+ States Have A Value-Based Reimbursement Adoption Strategy

by Jacqueline Belliveau

Over 40 states have a plan for value-based reimbursement adoption and only seven states have engaged in little to no activities relating to value-based healthcare payment reform, according to a new Change Healthcare report. The report showed...

Importance of Post-Acute Alignment, Integration to Value-Based Care

by Kyle Murphy, PhD

To achieve the ultimate goals of value-based care, healthcare organizations will need to assume greater responsibility over the patient’s experience across multiple care settings based on the appropriate level of acuity.   While the...

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