The Centers for Medicare & Medicaid Services, the nation’s largest payer, has set a clear direction with its publication of targets: By 2018, 50% of fee-for-service payments will be through alternative payment models, such as ACOs and bundled payments, and 90% of FFS payments will be tied to quality or value. And CMS has begun to introduce mandatory bundles. This suggests that all providers will
need to develop population health competencies, including the ability to manage risk for both cost and quality.
Most providers are involved in at-risk payment models of one kind or another. Their experience now should help them develop expertise that will be vital when value-based payments are the norm. Among the lessons to learn today is how to benefit from closer working relationships with payers in the future. In this latest report, peer leaders examine ways to benefit from closer working relationships with payers.
This paper is divided into two parts. The first part provides some background and a comparison of the types of episode analytics. Part two explores the real-world experiences of payers and providers in using episode analytics for payment bundling and other purposes.
Finally, we offer some recommendations on how to use episode analytics to reduce variations and manage contracts that involve financial risk.
PayerView, an annual healthcare payer rankings report by athenahealth, uses objective, data-driven methodologies to analyze the payer-provider relationship. The 2013 healthcare payer rankings report, which covers industry trends in 2012, does not show dramatic industry changes over the year, but highlights areas where there could be trouble as industry changes emerge.
"Healthcare payers and providers are under increasing pressure to:
- Provide and report on quality of care across their population
- Embrace new innovations faster
- Reduce costs across the organization
- Use consumer-friendly digital technology
Explore this actigraphic to see if your organization is on the right track for tackling these challenges."
Digital healthcare is not an unattainable mirage, but is alive and well in the United States and throughout the world. The goal of digital healthcare is to use technology to efficiently manage and deliver better healthcare—providing greater value and more positive outcomes to patients at a lower cost. The cloud provides the fastest, most efficient, and most economical way to reach that goal.
Ideally, cloud technology makes the delivery of healthcare fast, flexible, and easier for everyone to use—no matter whether you’re ordering supplies, hiring an employee, or reviewing your budget. However, actual results depend on how you implement the technology and on the vendor you choose as your provider. Every healthcare organization—payers and providers—will have a different path that leads them to digital healthcare. The question is, are you there yet?
The changing healthcare environment means that both payers and providers must use all of their available data to ensure that employee productivity goals are met, members and patients receive high-quality service, and compliance is maintained. Unfortunately, many organizations face challenges with disparate systems providing inconsistent data. Find out how leading healthcare organizations are integrating HR and finance systems for one source of truth, and in turn enabling better decisions.
Health insurers have long been plagued by issues of fraud, waste, abuse, error and corruption. Taking an enterprise approach to payment integrity – one that combines advanced data management and sophisticated analytics – can help payers detect and prevent fraud; effect positive change in how providers, employees and patients behave; and substantially reduce health care costs. Payers can achieve better outcomes when software support for the core disciplines of payment integrity run on a single platform.
Published By: Ipswitch
Published Date: Mar 14, 2014
In this case study, you’ll learn how Rochester General Hospital leveraged MOVEit’s point and click simplicity to set up, manage and track more than 70 different file transfer operations between hospital servers and the systems used by payers and outside healthcare providers.
- About the mandates that will significantly increase transaction complexity and transaction volumes for payers and providers
- How to reduce costs and improve processing efficiencies while also decreasing the risk associated with data movement
- Ways to improve customer service and ensure compliance with evolving regulations while reducing IT operating expenses