Interoperability has been a hot topic in the healthcare industry for over a decade and is a constantly recurring theme for organizations as they evaluate potential future technologies and how adopting those technologies will help them meet compliance requirements. The most urgent compliance concerns relate to the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F),…
Wider adoption of value-based care (VBC) would be a boon to our healthcare system by lowering costs and improving outcomes for all three P’s: patients, providers and payers. The Centers for Medicare and Medicaid Services (CMS) has led the charge on driving VBC adoption with a series of specialty VBC programs, including July’s launch of…
The shift from volume-based to value-based care in the healthcare industry revolutionizes how medical services are provided and reimbursed. While quality outcomes and patient satisfaction take center stage in this new model, the often-underestimated role of medical coding is becoming increasingly vital in ensuring its success. Understanding Value-Based Care In essence, value-based care ties reimbursement…
Accountable Care Organizations (ACOs), are at the forefront of the value-based care movement. But to truly excel, you need more than just a commitment to quality—you need data. The right metrics can illuminate your path to improved patient outcomes and cost savings. By tracking essential patient data, you’ll gain invaluable insights into your population’s health…
Milliman MedInsight combines data confidence with prescriptive insights and best-in-class analytics, to drive actionable results. Milliman MedInsight is one of the healthcare industry’s most highly regarded platforms for data warehousing and healthcare analytics. Their solutions have been adopted by over 300 health plans, employers, at-risk providers and ACOs, state governments, community health coalitions, and…
Is value-based care working in America? It’s a broad question, and the answer you get depends on whom you ask. In a 2023 survey of more than 400 providers, payers and payviders, most said they were currently engaged in value-based care (VBC) initiatives or were planning to launch programs soon. But there were mixed reactions…
A new report from the National Association of Accountable Care Organizations (NAACOS) shed light on the strategies that have driven the success of ACOs in adopting value-based care (VBC). Based on in-depth interviews with high-performing ACOs, the September 2024 ACO Drivers for Success report outlines 5 core strategies for effective ACO management, including working across…
Download Slides TP-ACO experts, Jay Simmons, MS-ISM, Vice President, Physician Services, Lauren Stuteville, RN, BSN, Transition of Care Coordinator, and HDAI’s Julie Woods, Manager of Customer Success, will share how an interdisciplinary team collaborated to successfully use HDAI’s HCC Recapture tool to address and optimize Hierarchical Condition Categories (HCCs) capture within their ACO population.…
Caitlin Walsdorf, a partner at HealthScape Advisors, a Chartis company, recently spoke with Healthcare Innovation about a new survey-based report that explores value-based care (VBC) implementation in dentistry. The survey was a collaboration between HealthScape, the CareQuest Institute of Oral Health and the National Association of Dental Plans. Walsdorf co-leads HealthScape’s Ancillary Center of Excellence focusing…
Dive Brief: The Biden administration has finalized a rule targeting fraudulent billing in Medicare’s largest value-based care program, after concerning reports of spiking spending on urinary catheters. The anomalous billing had the potential to hurt accountable care organizations, or ACOs, in the Medicare Shared Savings Program by impairing their ability to capture shared savings. ACOs are groups…