Modernizing Medicaid: Mega-Reg implications health plans should know

Payers manage a multitude of responsibilities as it relates to their Medicaid membership. From regulatory adherence, and payment integrity optimization to enrollment management, the current, and sometimes, complex canvas of Medicaid oversight is now growing.   The Department of Health and Human Services (HHS) issued a new ruling earlier this year with the intention to […]
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Understanding a new, mandatory payment model

As the health care industry moves toward population health management, providers and payers are working to determine which value-based reimbursement models show the most promise. The Centers for Medicare and Medicaid Services gave the bundled payments a boost this year by making the model mandatory for a number of hospitals — first for hip and […]
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Make patients the center of your provider network

All providers have one thing in common: they want their patients healthy and happy. Physicians, specialists, pharmacists, therapists and others work to deliver the highest quality care they can. But they primarily coordinate services independent of other providers. As value-based models become the norm, health care providers are quickly realizing that collaboration and cooperation between […]
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How an outstanding provider got even better with analytics

Lehigh Valley Health Network was already a pretty stellar health care organization. After all, it had been listed in US News & World Report’s “America’s Best Hospitals” 20 years running, and the American Hospital Association had numbered it among the “100 Most Wired” in 11 consecutive years. But the Pennsylvania provider wasn’t about to rest […]
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Using GIS to track Zika and microcephaly

For almost a year, the United States watched from afar as the number of Zika cases in Central and South America grew, with increasing numbers of infants born with the debilitating brain malformation known as microcephaly. As of August 31st, 2016, just over 2,700 cases of Zika had been reported in the U.S. — 35 […]
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Three factors to consider when implementing a VBR strategy

Health plans are facing significant, systemic changes as they move away from strictly fee-for-service payment arrangements and toward quality-focused, risk-based payment models. While health plans recognize that their existing financial and operational models must look different to accommodate these changes, they may be struggling with how to design and implement a risk-based reimbursement strategy. In […]
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Quality measures that matter

As the health care system transitions from volume to value, doctors are drowning in a sea of quality measures. According to a recent study published in the journal Health Affairs, U.S. physician practices in four common specialties are spending, on average, 785 hours per physician and more than $15 billion each year on reporting quality […]
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Relationships the secret to value-based health care success

Lehigh Valley Health Network (LVHN) executives believe no doctor, hospital or insurance company can stand alone and succeed in value-based care. That’s why the Pennsylvania-based system’s leadership emphasizes building relationships with internal staff and external partners — each of whom influences how the others perform. In the Spring/Summer edition of Optum RISKMATTERS, LVHN CEO Brian […]
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Transforming health care together — reflecting on Optum Forum 2016

Our week in Anaheim, California, was filled with engaging discussions, education and networking for more than 1,100 health care stakeholders from across the industry. We were joined by Optum leaders, subject-matter experts, and executives and professionals representing health plans, life sciences companies, government agencies, employers and provider organizations. Optum clients collaborated with solution experts to […]
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Keys to managing the top 10 HEDIS challenges

A health plan’s Star Ratings and bottom-line performance depend heavily on improvements made to quality measures and Healthcare Effectiveness Data and Information Set (HEDIS®) scores. The key to boosting HEDIS scores and gaining competitive advantage is to be proactive and meet its challenges head on. But what exactly does that mean? We’ve identified the top […]
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