Being prepared is sound strategy in all areas of life. The Boy Scouts live by it. Homeowners in hurricane zones stay ready for the worst. And health care executives know it’s the secret to longevity in the helter-skelter world in which they operate. Preparation is even more important now that value-based reimbursement is building momentum. […]
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Health care reimbursement isn’t as easy as a provider sending an invoice and the payer cutting a check. Since DRGs were introduced by Medicare in the early 80s, getting reimbursed for services performed has become increasingly complicated. Regulatory and industry changes related to the Affordable Care Act and the ICD-10 mandate have made it even […]
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The degree to which health care organizations have access to accurate and complete data will make or break a health care organization’s ability to respond to change. In the evolving world of value-based care, this rings true in how well leaders manage coding and documentation to improve performance. Of the five steps along the “optimizing […]
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In our previous post, we outlined how optimizing the technologies and processes behind clinical care is critical to optimizing performance in a value-based environment. The next step on the journey “Beyond the Curve of Health Care” involves medical necessity. Medical necessity can be burdensome, but its various rules must be followed to avoid significant penalties […]
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Our last blog discussed some of the new rules for optimizing patient access in the world of consumerism and value-based reimbursement. Today, we’ll take a look at optimizing the technologies and the processes behind clinical care. For a deeper look at ways you can optimize financial performance under value-based care, download the Optum eBook “Beyond […]
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In our previous Journey to Value post, we suggested four elements that organizations should consider as they as they determine their roadmap for value-based care. With a roadmap that accounts for market needs, financial impacts, provider network strategies and aligned incentives, organizations are ready to program the milestones around which they will convert to value-based […]
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In our last Journey to Value post, we discussed how having all key players in alignment allows a provider organization to better manage risk. There’s one element still to consider: the patient. To get a true handle on risk, health care providers must first understand the needs of the populations they’re serving. Here are four […]
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Cash is king, whether health care organizations like it or not. Moving from volume- to value-based care puts revenue at risk when cash flow is critical. There are three specific areas where organizations can improve revenue: Denials management — Denied claims limit cash flow and negate work already completed. Plus, they add more work for […]
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Health care is driven by the wants and needs of the market. Consumers want better transparency and value at the same time governments, payers and employers are trying to keep costs down and stimulate quality improvement. This means more pressure on providers to deliver efficient care while not passing on costs to patients. But, making […]
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