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

Value Based Purchasing

Key Capabilities for Value-Based Reimbursement Models

December 7, 2017 - 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 and providers should carefully consider the skills and infrastructure needed to succeed in certain models, including pay-for-performance,...


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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,...

Mortality Rates Rose After HRRP Value-Based Penalty Enforced

by Jacqueline Belliveau

Short and long-term mortality rates increased for Medicare beneficiaries hospitalized for heart failure after Medicare implemented the value-based penalty component of the Hospital Readmission Reduction Program (HRRP), a new JAMA Cardiology study...

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...

29% of Healthcare Payments Under Alternative Payment Models

by Jacqueline Belliveau

About 29 percent of healthcare payments in 2016 were paid through an alternative payment model, such as shared savings/risk arrangements, bundled payments, or population-based reimbursements, the Health Care Payment Learning and Action Network...

Pay-for-Performance Models Hurt Safety-Net Hospital Finances

by Jacqueline Belliveau

Medicare pay-for-performance models may disproportionately penalize safety-net hospitals and other organizations that serve the most vulnerable patient populations, a new study in Medical Care found. Hospitals in one of the most socioeconomically...

Value-Based Reimbursement Shift Slows, But CEOs Still Preparing

by Jacqueline Belliveau

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 Health...

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

by Jacqueline Belliveau

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 navigating...

ACOs Plan to Move to Downside Financial Risk, Capitation Contracts

by Jacqueline Belliveau

Accountable care organizations (ACOs) are planning to enter downside financial risk arrangements, with 47 percent planning on entering a shared savings and losses contract and 38 percent pursuing capitation, uncovered a recent survey of 240 ACOs...

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

by Jacqueline Belliveau

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 to...

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

by Jacqueline Belliveau

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 further transition...

Cost Data to Improve Quality Reporting, Value-Based Purchasing

by Jacqueline Belliveau

Providers enter value-based purchasing contracts without understanding the cost of quality reporting on measures listed in their contracts and payers rarely use cost data to determine which metrics to use when linking reimbursement to...

CMS Offers Value-Based Purchasing Exceptions After Hurricane Harvey

by Jacqueline Belliveau

  Providers practicing in areas affected by Hurricane Harvey will not have to report to several Medicare and Medicaid quality reporting and value-based purchasing programs, CMS recently announced in an...

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

by Jacqueline Belliveau

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 to be...

Orgs Offer Regulatory Relief to Boost Value-Based Purchasing

by Jacqueline Belliveau

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 have recently...

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

by Jacqueline Belliveau

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, high-quality...

Mixed APM Results Offer Lessons for Healthcare Payment Reform

by Jacqueline Belliveau

The verdict is still out on whether key alternative payment models, such as accountable care organizations (ACOs) and bundled payments, reduce healthcare costs and improve care quality. But the mixed results should not discourage the industry...

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