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Mastering interviews: Tips for managed care executivesTips to help healthcare executives present their most authentic selves during remote interviews.
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Proposed healthcare payer mergers are under reviewFederal antitrust officials are determining how, and if, transactions will move forward. Here's a roadmap of what's ahead in 2016.
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High-cost patient populations: 3 areas to addressThe solution to succeeding in value-based reimbursement models is to start inside the hospital with high acuity patients and build the systems that support them.
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Four data analytics initiatives to implement nowInnovation will be necessary to compete for consumers in the new market environment. Using data effectively can help plans stand out.
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Risk sharing grows in the Medicaid spaceWhile forming risk-based entities among Medicaid providers could be an effective way to better manage the care of low-income populations, the risk of unintended consequences cannot be ignored. A key hedge against these consequences is better use of patient data.
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Four considerations when moving to value-based paymentHere are four critical considerations that are integral to successful implementation of a value-based payment model.
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Imaging programs reduce costsUnnecessary diagnostic tests are harmful to patients and costly for health plans.
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US healthcare costs accelerateSince posting its lowest annual growth rate in more than six years, the average cost of healthcare services accelerated in May and June.
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Patient visits should go back to the basicsSometimes in our technology-driven environment, we get into a fixed routine of the current standard of care for our patients. What would we see or hear if we saw our practice or facility through the eyes and ears of our patients?
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How FDA Plans to Encourage More Biosimilar UptakeThe hope is that more biosimilars will lead to more access and more affordable medications, but biosimilar uptake is lagging. Here’s why and how FDA hopes to fix it.
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The Hospital of the Future: Balancing Risk, Revenue in Post-Pandemic WorldHealthcare providers have increasingly entered into value-based contracts with payers in recent years because they offer the opportunity to increase revenue-the primary driver of change for any business.
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One system's experience with scriptingEffective maintenance of patient records, registration information, human resources documentation, and reimbursement forms are critical to the IT success of the four-hospital Saint Clare's Health System, in northwestern New Jersey. The hospital system, which houses more than 475 active beds, serves 23,000 inpatients and 250,000 outpatients annually.
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New expectations raise standards for identity managementIn 2007, healthcare providers will face identity and access management challenges that will directly impact compliance, security and audit issues.
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Integrated, flexible incentive programs encourage changeConsumerism in health benefits has moved beyond buzzword status to a mainstream strategy. Increasingly, health plans and employers view consumerism with a global approach to benefits-a collaboration with employees financially, organizationally and personally.
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Games for health have become serious opportunities for plansHealthcare gaming has made progress in the past year by allowing consumers to engage in health via mobile devices.
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Top Challenges in Managing DiabetesThe leading problems that endocrinologists and educators see from their daily interactions with diabetes patients.
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Commercial Blues plans adopting the CMS do-not-pay list policyIn a move toward accountable care, the Blue Cross and Blue Shield Assn. (BCBSA) has established a policy that denies acute care hospitals reimbursement for certain never events.
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Report: Medical Costs to Rise 7% Next YearThe increase is expected to be somewhat offset by the impact of biosimilars coming to market and more care being provided in outpatient settings.
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Leverage health data gathered from electronic recordsSecondary use of electronic data from claims and clinical sources will drive savings
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FDA prioritizes drug safety, expects industry to be proactiveMore than 4 million annual provider visits, including visits to the ER, can be attributed to adverse drug events
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Michigan’s Medicaid Program Plans to Save Millions By Eliminating PBMsThe state’s desired savings and efficiencies can be realized, but will likely take some effort.
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Opinion: The Best Lesson We Can Learn from the German Healthcare SystemAs President Trump intensifies his battle with German Chancellor Angela Merkel over trade and NATO policies, he should pause to consider the lessons from another German Chancellor-Otto von Bismarck.
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Shifting employees to exchanges provides no real advantageAmong the decisions employers are tackling is whether to keep their group health plans.
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Payment reform redefines provider performance managementA health plan's approach to provider reimbursement is rooted in the need to move from traditional fee-for-service models to a payment model that accounts for providers adhering to best practices.
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Take steps to prepare for insurance exchangesInsurance exchanges will not exist in a vacuum; they will touch every part of the healthcare system and require substantial changes to the way payers do business.
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Review health risk assessment use under new GINA rulesFinancial incentives and penalties are no longer permitted when genetic information is requested on health risk assessments
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Kentucky co-op leverages outreach during open enrollmentNew members likely to have more chronic conditions
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States move forward with unique ACO models for MedicaidEarly efforts by states drive value with Medicaid ACOs, coordinated care.
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Elevating to ICD-10: It may be a great fit for healthcareThe World Health Organization's latest version of the International Classification of Diseases and Related Health Problems (ICD) will bring "the good, the bad, and the ugly" for nearly all who use this classification system. However, the biggest asset is that the latest version is much more detailed and organized than ICD-9.
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Elevating to ICD-10: It may be a great fit for healthcareThe World Health Organization's latest version of the International Classification of Diseases and Related Health Problems (ICD) will bring "the good, the bad, and the ugly" for nearly all who use this classification system. However, the biggest asset is that the latest version is much more detailed and organized than ICD-9.
