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

Value Based Care

Addressing Quadruple Aim, Physician Burnout Key to Risk Success

by Jacqueline LaPointe

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...

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

by Jacqueline LaPointe

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...

40+ States Have A Value-Based Reimbursement Adoption Strategy

by Jacqueline LaPointe

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...

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....

Full Risk Value-Based Care Key to Treating Vulnerable Patients

by Jacqueline LaPointe

Oak Street Health, a 24-primary care network headquartered in Chicago, aims to rebuild healthcare as it should be using value-based care contracts with full financial risk. The health system’s mission is to deliver personal,...

Choosing Wisely Slow to Reduce Low-Value Care, Resource Use

by Jacqueline LaPointe

Participation in the Choosing Wisely campaign has significantly increased since its launch in 2012. But the campaign has yet to realize its goal of decreasing low-value care and resource use, a recent Health Affairs report...

Value-Based Reimbursement Shift Slows, But CEOs Still Preparing

by Jacqueline LaPointe

Hospital and health system CEOS are gearing up for alternative payment models and population health management, but the transition to value-based reimbursement is taking more time than expected, a recent survey from Deloitte Center for...

AMA Pres: Align MIPS Improvement Activities with APM Demands

by Jacqueline LaPointe

Providers can ensure their investments in the Merit-Based Incentive Payment System (MIPS) are worth it by engaging in Improvement Activities and other practice transformations that enhance overall Medicare performance and lead them to the...

Provider Data Integrity Key to Directory Accuracy, Value-Based Care

by Jacqueline LaPointe

Providers and their payers oftentimes have a love-hate relationship. Payers boost the number of patients walking through physician office doors using provider directories as well as reimburse providers for treating those patients. But...

Do Alternative Payment Models Overcome Fee-for-Service Flaws?

by Jacqueline LaPointe

While alternative payment models, such as pay-for-performance, shared savings and risk, and bundled payments, were designed to improve the flawed fee-for-service system, the models are not addressing volume-based payment issues, according...

CO’s Pediatric Care Network Brings Value-Based Care to Children

by Jacqueline LaPointe

Medicare has led the healthcare industry as it shifts from fee-for-service to value-based care, with 30 percent of traditional Medicare reimbursements already paid under an alternative payment model. The federal government plans to...

Prioritizing Value-Based Care, Affordability in Medicaid

by Jacqueline LaPointe

WASHINGTON DC - The future of Medicaid involves providing value-based care at an affordable price for all beneficiaries in the program, Kaiser Permanente’s CEO Bernard J. Tyson told attendees at AHIP’s National Conference on...

Payer, Provider Collab, Home Health Key to Integrated Care

by Jacqueline LaPointe

WASHINGTON DC - The move to integrated care models that treat the whole individual, not just his medical needs, rests on payer and provider collaboration as well as linking healthcare and lifestyle, Humana’s CEO and President Bruce...

How Healthcare Reform, Value-Based Care Define High-Performance

by Jacqueline LaPointe

Whether through the Triple Aim or Institute of Medicine’s six aims, healthcare reform efforts and value-based care models intend to transform health systems and hospitals into high-performing entities. But what exactly does it mean...

Orgs Offer Regulatory Relief to Boost Value-Based Purchasing

by Jacqueline LaPointe

In response to the recent CMS call for stakeholder feedback on how to provide regulatory relief, industry groups detailed ways to reduce red tape associated with value-based purchasing implementation. Hospitals and individual providers...

How Palomar Health Created a High-Value Post-Acute Care Network

by Jacqueline LaPointe

Ensuring patients receive high-value care delivery during their hospital stay or office visit is a top priority for healthcare providers. But value-based purchasing models are pressuring doctors to extend that same cost-efficient,...

AMGA: MIPS Exclusion Rules Inhibit Value-Based Care Under MACRA

by Jacqueline LaPointe

The American Medical Group Association (AMGA) recently opposed several proposed changes to the Quality Payment Program and its Merit-Based Incentive Payment System (MIPS) for the 2018 performance period. The group particularly expressed...

Post-Acute Care Payment Reform Threatens Rural Hospitals

by Jacqueline LaPointe

A proposed unified Medicare reimbursement for post-acute care services and value-based care payment models, such as accountable care organizations (ACOs) and bundled payments, may propel rural hospital closures as the reforms lower their...

Small Health System Achieves ROI with Asthma Management Clinic

by Jacqueline LaPointe

Asthma is one of the most expensive chronic diseases for providers, payers, and patients. But a recent study in the American Journal of Managed Care showed that a stationary pediatric asthma management clinic can achieve a return on...

Health Center Work Conditions Drop After Practice Transformation

by Jacqueline LaPointe

Improving work conditions for clinicians and staff members may be key to implementing practice transformations for value-based care in federally qualified health centers (FQHCs), a new Health Affairs study suggested. Recent survey results...

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