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

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Three Additional MCOs Signed For State Medicaid Health Services in KY

Anthem, Humana and Passport have signed agreements with the Cabinet for Health and Family Services to provide healthcare services to state residents who will be newly eligible for coverage under the expansion of Medicaid, a provision of the Affordable Care Act.

The three new MCOs are in addition to Coventry and WellCare, which are currently serving this area, officials said.

Beginning October 1 residents in 104 Kentucky counties who are determined to be newly eligible for Medicaid will be able to choose the health plans as their healthcare provider for coverage effective Jan. 1, 2014.

“Under the terms of the contract, the three MCOs will initially serve exclusively the more than 300,000 who will be newly eligible for Medicaid,” officials said. Continue reading

Take Your Corners – Hospital Health Plan Negotiation Strategies

Hospital managed care teams need to understand their markets are much more expansive than other hospital competition, advises, a senior exec with a company that provides a range of services to providers.

“Essentially, there are three basic ways of dealing with negotiation differences: Continue reading

Accountable Care Organizations Getting More Scrutiny

A number of independent practice associations (IPAs) and other physician organizations – PHOs, multi-specialty medical groups and hospitals have created new accountable care organizations.

Because we produce the National Directory of Physician Organizations, we naturally are following ACO developments.

ACOs are very much top-of-mind as ACO numbers grow. And with that awareness comes increased attention. Continue reading