Within the health care system, payers and physicians have long operated at odds with one another. While both have a goal to improve patient and member health, their approaches often differ, creating friction. Physicians get frustrated when they have limited information about how data are collected and used to calculate patient attribution and payments. They…
Pediatrics has been at the forefront of preventive medical practices such as immunizations, screenings, care coordination with specialists and meeting defined health goals. Measurable prevention is a major cornerstone of providing value-based care, so it would seem the approach would pair well with pediatrics. But it’s not that simple, because there is a wide range…
Reimbursement issues at nursing homes are pushing operators to adapt their payment models to increase reliance on Institutional Special Needs Plans (I-SNPs) and Accountable Care Organizations (ACOs). But while these models aim to enhance care quality even as they control costs, they also bring on unique challenges, including requiring extra oversight with discharges and related…
Many healthcare delivery organizations have adopted some form of value-based payment model in recent years, shifting the healthcare focus from quantity of services to quality of outcomes. In a promising trend for healthcare overall, more than half of healthcare payments in 2023 were part of a value-based care reimbursement model. Capitation – which provides a set fee per…
The benefits of artificial intelligence (AI) include predictive analytics, personalized treatment plans, operational efficiency, and and remote patient monitoring, says Liz Kwo, MD, MBA, MPH, chief commercial officer, Everly Health; faculty lecturer, Harvard Medical School, and author of the book, DigitalMD. This transcript has been lightly edited. Transcript How can AI effectively contribute to value-based…
Allegations of fraudulent billing for catheters in 2023 will not affect calculations when Medicare analyzes financial performance of accountable care organizations (ACOs). The U.S. Centers for Medicare & Medicaid Services (CMS) has opened a 30-day public comment period on its “Proposed Rule on Mitigating the Impact of Significant, Anomalous, and Highly Suspect Billing Activity on…
Stakeholders are pleased with a Centers for Medicare & Medicaid Services (CMS) proposed rule to address the impact of widespread anomalous billing and suspected fraud involving urinary catheters that impacted Medicare accountable care organization (ACO) results. According to a Feb. 24 story in the New York Times, more than 450,000 Medicare beneficiaries accounts were billed…
Dear Healthcare Professionals, In an era where regulatory scrutiny is intensifying, the significance of governmental coding audits within the healthcare sector cannot be overstated. These audits serve as a cornerstone for maintaining compliance, ensuring the integrity of medical billing and coding practices. It is crucial to understand the complexities of these audits so you can…
This week, health data platform Arcadia made an acquisition that CEO Michael Meucci thinks will give the Boston-based company the data it needs to offer a more comprehensive suite of value-based care technology for its customers. It bought Arlington, Virginia-based CareJourney, a health analytics firm designed to facilitate participation in value-based care contracts. The acquisition…
Download Slides In this webinar, we will delve into the pivotal journey of interoperability in healthcare, exploring the significance of the Trusted Exchange Framework and Common Agreement (TEFCA), current data insights, and future directions. In this session, we will discuss: The Road That Got Us Here:– A historical overview of interoperability in healthcare.– Key…