Tag Archives: Medicare

Understanding the risks of incomplete medical coding

Information that could affect readmission risks, reimbursement, quality assessments and more is missing from medical records according to a recent study. MedPageToday reported on the study, conducted by researchers at Johns Hopkins University School of Medicine and published in November 2015 in the journal PLOS ONE. The researchers compared two large databases – one based on claims […]
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Timing a transition to value-based care

Once providers decide they will transition to value-based care, the next question is when should they make their move. Providers can do more than pick an arbitrary date. There are tools to help organizations make informed decisions on transition timing. Providers can conduct a financial impact assessment. Doing so allows groups to model several factors […]
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Comfortable managing chronic illness? Ready for what’s next?

When just beginning the shift to data-driven value-based care, health care providers can start by focusing on one clearly defined population. But true population health management is about successfully administering care for all patients attributed to an organization. So how do providers travel the path from novice to intermediate levels of care management? Once a […]
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Documenting diagnoses makes a difference in care quality.

An often-repeated statistic warns that 8 million Americans have diabetes and don’t know it. There are similar claims about other chronic illnesses, like hypertension and chronic heart failure. If a patient doesn’t know they are missing a diagnosis, their health care provider may not either. The white paper Accurate coding: The foundation of accountable care explains that […]
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Preventive care: Gauge potential to drive revenue

Say your patient population is the size of Cincinnati and Toledo combined, you might be able to fill up my beloved Buckeyes’ Ohio Stadium with patients who’ve skipped two years of well visits. I’m talking about 18 percent of your patients missing out on preventive care. What would closing that gap in care mean to […]
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Engaging in risk-based contracts? Get an actuary’s opinion

Health care providers across the country are looking at ways they can increase their clinical and financial risk exposure under value-based contracts. But if they’re not experienced with risk, they may enter into contracts that put them in difficult situations. The consequences of bad risk contracts could include poor cash flows, non-competitive rates resulting in […]
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Provider executives share insights on the evolution of population health

How can you adapt to population health? If you’re a health care provider, such a question can’t be answered in a sentence or a paragraph—or even an entire article. But providers who are undergoing a fee-for-service to fee-for-value transformation have offered some insight into how and why they’re evolving to become excellent at managing the […]
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Using data to move toward transparency: Six things health care providers can do

In our previous blog, “RISK now matters to health care providers”, we introduced the RISKMATTERS publication from Optum and touched on the latest conversation in the spring edition—health care providers managing financial risk becoming data-rich and insight-strong. And a new trend report in the spring edition, Transparency becoming health care’s new normal, kicks off the […]
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RISK now matters to health care providers

For the past several years, the U.S. health care industry has undergone a significant transformation in its payment structure, with many organizations evolving from supporting the current fee-for-service to a value-based payment model. A 2015 U.S. Department of Health & Human Services news release articulated its support for a new model when it set a […]
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Transparency provides competitive edge for health care providers

As high-deductible health plans become increasingly popular, cost may become a primary deciding factor for consumers seeking medical providers. But that doesn’t necessarily mean that consumers want the cheapest price. Instead, they want to spend their dollars wisely by understanding pricing and seeing clear accountability for outcomes. In a word, they want transparency. “The future […]
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