Focus On Data in Era of Value-Based Models of Reimbursement

“Despite the continued prevalence of the traditional fee for service reimbursement models as the primary method of payment, over time healthcare’s reimbursement will give way to value-based models of reimbursement.”

That prediction made by longtime friend and consultant Russell Foster surrounding the need for accurate data as value-based models of reimbursement continue to emerge has come true.

You know that valued-based reimbursement today is a significant focus. Payer reimbursement strategies are tipping in favor of providers who can deliver the clinical and financial goods. In the mix are bundled payments, shared savings, pay for performance and bonuses.

Payment Bundling, PHO Shared Savings, and Pay for Performance are all in the mix of emerging models of episode-based payments, physician-hospital organizations and physician bonus structures.

One major health payer’s 6,300 enrolled primary care physicians can earn bonus payments across six measure sets — a broad spectrum of measures from clinical and quality measures to prescribing Continue reading

Advertisements

Health Plan Member Satisfaction in 2014

Issues surrounding the time a member must wait after a pre-approval request has been submitted to their health plan before they hear from their provider, to concerns about having adequate health coverage, and health plan notices of changes in their coverage, networks or rates are having an impact on members satisfaction with their plan, found a recent study.

Some 41 percent of existing health plan members believe that they lack enough coverage for routine visits, serious illness or injury, health and wellness programs, routine diagnostics and drug coverage, found the study by market research firm J.D. Power.

Concerns over not having enough health coverage negatively impacts overall satisfaction by 133 points, more than any other coverage-related issue, according to the J.D. Power 2014 Member Health Plan StudySM.

The study, in its eight year, measures satisfaction among members of 136 health plans in 18 regions throughout the United States by examining six key factors: coverage and benefits; provider choice; information and communication; claims processing; cost; and customer service.

—————————————————
The National Directory of Managed Care
Organizations Database for Your State

Need a list of health plans just for the state that you are in?
You do not need to buy an entire directory of managed care or list of HMOs
for the whole country when you only need to know about the health plans in your state.
And its affordable.
Find out more: National Directory of Managed Care Organizations Database for Your State
—————————————————-

In 2014, overall member satisfaction averages 669 (on a 1,000-point scale), the firm said.

Key Findings include:   Continue reading

What is Being Thrown into Your Healthcare Reimbursement Stew: All with a Goal of Care Improvement

Bundled payments, new models of reimbursement, care transitions, value-based reimbursement, readmission penalties, are all part of the jargon in payer and provider circles today.

And there is no lack of opinions on what new or a combination of all is the answer to quality care, cost savings and outcomes results. All approaches come with some risks to providers and financially to payers.

On the eve of the new year, the Centers for Medicare & Medicaid Services (CMS) released the health care organizations selected to participate in  the Bundled Payments for Care Improvement initiative, an innovative new payment model.

“Under the Bundled Payments for Care Improvement initiative,” organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare,” CMS said. Continue reading

What is Being Thrown into Your Healthcare Reimbursement Stew: All with a Goal of Care Improvement

Bundled payments, new models of reimbursement, care transitions, value-based reimbursement, readmission penalties, are all part of the jargon in payer and provider circles today.

And there is no lack of opinions on what new or a combination of all is the answer to quality care, cost savings and outcomes results. All approaches come with some risks to providers and financially to payers.

On the eve of the new year, the Centers for Medicare & Medicaid Services (CMS) released the health care organizations selected to participate in  the Bundled Payments for Care Improvement initiative, an innovative new payment model.

“Under the Bundled Payments for Care Improvement initiative,” organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare,” CMS said. Continue reading

Health Systems Seen Needing New Strategies to Reorganize Delivery Models

To succeed in this new post-health reform arena, Health systems should prioritize information technology infrastructure development, information sharing, and timely distribution of information to ensure outstanding patient care, prepare for a patient-centered medical home and bundled payment system, and move toward best practice levels of care coordination, according to Health Strategies & Solutions, a Philadelphia-based consulting firm.

“The Supreme Court decision to uphold the major provisions of the ACA launches a new era in health care in the United States. Development of a robust foundation of primary care services must move to the forefront of strategic priorities for all health care providers,” the firm, with offices in a number of states, says in a white paper.

According to the firm’s white paper “Primary Care In An Era of Healthcare Reform” health care organizations that  Continue reading

New Physician Organization Leadership Survey Seeks Insight – Opinion

The Managed Care Information Center periodically conducts our Physician Organization Leadership Survey to identify the issues, challenges and opportunities today for physician organizations.

We are seeking survey responses from those engaged in the management and administration of or who are members of such physician organizations as IPAs, PHOs and MSOs.

For your participation in this brief survey, we will send you free an executive summary of the analyzed results.

What are the ‘looming’ challenges? Any opportunities? What is the most pressing concern from your perspective?

The survey only takes a few moments. You do not have to identify yourself if you choose.

As you know, survey results are reported in the Managed Care Information Center reports, in our Managed Care Weekly Watch, as well as the MCIC Blog, Facebook and Twitter and are posted at our website.

To participate in this survey, go click on this link now: http://bit.ly/JhFn9o

If you are connected with executives of members of PHOs, IPA or MSOs, please let them know about this survey.

Members in Consumer-driven Health Plans Seen More Educated, Healthier, Wealthier

New findings of a study of members enrolled in consumer driven health plans has found that those individuals tend to have higher incomes, higher educational levels, and report better health behavior than do those in traditional health plans.

The report was produced by the nonpartisan Employee Benefit Research Institute (EBRI). The study examined trends over the 2005–2011 period.

Consumer-driven health plans (CDHPs) generally consist of high-deductible health plans (HDHP) with either a health reimbursement arrangement (HRA) or Health Savings Account (HSA).

As of 2011, some 21 million individuals, representing about 12 percent of the market, were either in a CDHP or an HSA-eligible health plan, the report said.

“Consumer-driven health plans are a growing presence in the health insurance market, so it’s important to understand how they differ from traditional health plans,” observed Paul Fronstin, author of the report and director of EBRI’s Health Research and Education Program.

He said it is “often assumed that CDHP enrollees are more likely to be young than those with traditional coverage, because they use less health care, on average. However, in most years, the survey found that CDHP enrollees were less likely than those with traditional coverage to be between the ages of 21 and 34.”

Other findings from the EBRI report include:

  • CDHP enrollees were roughly twice as likely as individuals with traditional coverage to have a college or post-graduate education. HDHP enrollees were also more likely than traditional-plan enrollees to have a college or graduate degree.
  • CDHP enrollees have consistently reported better health status than traditional-plan enrollees.
  • During the survey period, HDHP enrollees have been consistently less likely than those with traditional coverage to report that they smoke, but no recent differences were found in exercise rates, and differences were not found in obesity rates.

For more information following is a link to EBRI’s news release:

http://www.ebri.org/pdf/PR968.26Apr12.CDHPs.pdf