Tag Archives: reimbursement

Do bundled payments encourage more procedures? New study offers answer

New research aims to determine whether a claim that bundled payments may actually increase costs rather than control them holds any weight. Becker’s Hospital Review and McKnight’s reported on the study from the Centers for Medicare and Medicaid Services and the Altarum Institute. At issue was whether bundled payments — also known as episode-based payments […]
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Is a provider-led health plan a good fit? Evaluate 6 areas to find out

To drive down costs and improve care through value-based models, one must have a deep understanding of the population they serve. Health care providers have this knowledge. Their familiarity with the demographics, economics and general needs of their communities means some are well-positioned to launch their own provider-sponsored health plans (PSHP) and have a sense […]
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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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Addressing the possible effects of overlapping reimbursement models

At the core of bundled payments is the goal of improving coordination between all of the facilities and agencies a patient might visit or employ during one episode of care. But as health care providers adjust to this new reimbursement model, some are experiencing trouble coordinating bundled payments with other value-based care initiatives. In the […]
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Optimize performance to accelerate your value-based journey

It’s no secret that health care providers have abundant opportunities to save. Some estimates put the dollar figure in the hundreds of billions in revenue that is lost due to unnecessary expenses, missed income and inefficiencies each year. Executives can play a vital role here in reclaiming these lost resources. You can analyze and pinpoint […]
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Lessons learned from payers aid in shift to value-based care.

As fee-for-value payment models replace fee-for-volume models, providers are more often managing medical costs and risk. These are roles once dominated by payers. As providers find themselves needing to analyze risk, they can learn from health plans, employers and other payers — and adopt some of the same tools they use. One tactic providers can […]
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Providers can prepare to negotiate risk-based contracts.

Launch a web search for physicians and contracts. Much of the information you’ll find relates to employment contracts — agreements of hire, salaries, on call hours. But, with the changing health care industry doctors, hospitals and other providers are finding themselves negotiating new kinds of contracts. They are sitting down across the table from payers […]
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Changing reimbursement models requires changes to physician compensation models – the value of unblinded performance metrics

In my final blog related to changing reimbursement models requiring changes to physician compensation models, I want to identify the value of sharing unblinded information once physicians have approved, digested and absorbed the compensation model. Many of the organizations I have talked to find unblinded incentives to be a very powerful tool. However, you need […]
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Changing reimbursement models requires changes to physician compensation models – A structured approach to implementation

My previous blog, “Changing reimbursement models requires changes to physician compensation models – Characteristics of value-based compensation model,” outlined that as provider organizations move to risk-bearing contracts there are characteristics that go beyond just measuring quality of care and patient outcomes. A structured approach to engaging physicians is required to ensure long-term adoption and ultimate […]
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Risky business for providers: Developing a value-transformation roadmap

The ultimate goal for provider risk-bearing is to develop a system that focuses on local market needs and planning for patient engagement at all levels. To get there, organizations need a comprehensive, strategic value-transformation roadmap—our fifth and final risk-bearing action for provider organizations.