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

Value Based Reimbursement

29% of Healthcare Payments Under Alternative Payment Models

by Jacqueline LaPointe

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...

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...

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

by Jacqueline LaPointe

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...

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...

ACOs Plan to Move to Downside Financial Risk, Capitation Contracts

by Jacqueline LaPointe

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...

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...

Bringing Back House Calls to Cut Spending on High-Risk Patients

by Jacqueline LaPointe

Before the early 1960s, the majority of healthcare visits were performed in patient homes. But as healthcare evolved, providers could no longer fit their tools in a transportable medical bag and the proportion of visits made by house calls...

Cost Data to Improve Quality Reporting, Value-Based Purchasing

by Jacqueline LaPointe

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...

CMS Offers Value-Based Purchasing Exceptions After Hurricane Harvey

by Jacqueline LaPointe

  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...

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,...

Mixed APM Results Offer Lessons for Healthcare Payment Reform

by Jacqueline LaPointe

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...

Private Sector to Drive Bundled Payments After CMS Cancellations

by Jacqueline LaPointe

CMS recently announced its intention to modify its bundled payments strategy by proposing to eliminate forthcoming mandatory cardiac models and decreasing the scope of the Comprehensive Care for Joint Replacement (CJR) program. The pull...

Cost Savings Unclear for Medicaid Alternative Payment Models

by Jacqueline LaPointe

Alongside Medicare and private payers, states are making the switch to value-based reimbursement, but states and independent researchers have yet to demonstrate the impact of Medicaid alternative payment models on healthcare costs and...

Physician Expert, Clinical Documentation Key to MIPS Success

by Jacqueline LaPointe

Since the Obama administration signed MACRA into law in 2015, healthcare providers have been attempting to understand the Quality Payment Program and its Merit-Based Incentive Payment System (MIPS). But regular updates and tweaks to MACRA...

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...

Accountable Care Organizations Grow, But Face New Challenges

by Jacqueline LaPointe

Since the Affordable Care Act paved the way for accountable care organizations (ACOs) in 2010, healthcare providers have increasingly turned to the alternative payment model as a way to engage in value-based care across patient...

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