As part of its ongoing mission to improve the health of America, the Blue Cross Blue Shield Association (BCBSA) announced its National Health Equity Strategy in April 2021 to confront the nation’s crisis in racial health disparities. This strategy is intended to change the trajectory of health disparities and reimagine a more equitable health care […]
Here are the six best reimbursement stories from 2021 HealthLeaders’ coverage and beyond. COVID-19 continued to impact healthcare reimbursement as the pandemic entered its second year. Yet, what’s different is that longer-term strategies and new business opportunities are emerging beyond crisis response. The Centers for Medicare & Medicaid Services (CMS) aided these plans by extending […]
Over half of health systems also said they plan to advance risk-based payments or some form of capitation in commercial lines of business. The executive survey conducted by the Healthcare Financial Management Association (HFMA) for the Guidehouse Center for Health Insights found that nearly 60 precent of health systems are looking to advance into risk-based […]
The pandemic has changed patients’ use and perceptions of healthcare organizations. The question remains: Will those changes here to stay? PATIENTS PREFER TELEHEALTH SERVICES FROM DOCTORS, HEALTH PLANS Most telehealth users accessed virtual care services through their regular doctor or health plan as opposed to direct-to-consumer telehealth platforms, according to new data from Morning Consult. […]
Affordability, simplicity, and accessibility remain the three targets that payers aim to hit during Medicare open enrollment season, according to Christopher Ciano, president of Aetna Medicare. Listen to the full podcast to hear more details. And don’t forget to subscribe on iTunes, Spotify, or Google Podcasts. The push for greater affordability is perhaps most evident […]
Organizations that do strong vendor relationships, invest in the organization, and are willing to take on commercial risk will be poised to take on downside risk financial contracts. Through working with population health management vendors, KLAS released a recent report identifying which of their customers are most advanced in adopting downside risk contracts. In the […]
Claims management is a multi-step process that provides ample opportunity for errors and delays, but if payers modify their approach to certain steps in the process it could have a positive impact overall. In the most concise language, claims management starts with a provider sending a claim or prior authorization request to a payer. The […]
The COVID-19 relief bill the House passed Wednesday is a major win for various sectors in the healthcare industry, and includes the biggest update to the Affordable Care Act since it was enacted 11 years ago this month. The $1.9 trillion American Relief Plan was approved by a party line vote of 220-211, having made it […]
The COVID-19 pandemic continues to send more Utah residents to hospitals. Given the rise in hospital visits, addressing the need for cost transparency and clarity for patients has become more urgent than ever. Surprise Medical bills, a familiar issue, is receiving even more attention and press coverage during this unprecedented time. In a 2019 Kaiser […]
Prior authorizations, or prior approvals, are strategies that payers use to control costs and ensure their members only receive medically necessary care. The cost-control process requires providers to acquire advance approval from payers before delivering specific services or items for a patient. Payers are increasingly using prior authorizations to lower their costs and improve care […]