Accountable Care

September 15, 2014 | Anthony Brino

Ahead of a corporate branding change and a new open enrollment period, WellPoint is charging ahead with accountable care and population health strategies.

September 12, 2014 | Anthony Brino

As proton cancer treatment centers expand, payers and providers may have to collaborate to expand the evidence base, to avoid the highly-expensive technology crowding out other investments.

September 12, 2014 | Richard Pizzi

Weill Cornell Physicians, Cornell University's physician group, has inked a new accountable care agreement with Aetna, intended to enhance care for approximately 9,000 of the insurer's commercial and Medicare members in New York.

September 9, 2014 | Anthony Brino

For the many health organizations trying out or diving into accountable care, there are some important ideas from abroad to consider during the next stages of design and evaluation.

September 8, 2014 | Anthony Brino

Aetna's ACO portfolio keeps growing, as the insurer tries to capitalize on Medicare Advantage rate pressure and step in where some competitors face upheaval.

August 27, 2014 | Anthony Brino

Clinical integration and accountable care developments in greater Philadelphia are taking a novel turn, with one large insurer teaming up with a new multi-health system collaboration.

August 26, 2014 | Anthony Brino

A regional payer-provider dispute over costs and value is showing that troubles can arise amid efforts to design reforms and move away from fee-for-service.

August 21, 2014 | Healthcare Payer News Staff

Over a five-year period, five programs sponsored by Blue Cross Blue Shield of Michigan and Blue Care Network to improve the quality of certain medical and surgical procedures performed in Michigan hospitals, have produced $597 million in healthcare cost savings, and have lowered complication and mortality rates for thousands of patients.

August 15, 2014 | Anthony Brino

The Affordable Care Act is boosting short-term finances for insurers and providers alike. Long-term, though, traditional business models appear untenable and health organizations must evolve to remain sustainable.

August 7, 2014 | Anthony Brino

The diabetes crisis and pay-for-value evolution are coming to a head, helping change provider reimbursement in Medicaid.

August 6, 2014 | Anthony Brino

Access to prices and just a bit of nudging seems to not only help members find the best deals on elective health services like imaging but also spur some competition among providers.

August 5, 2014 | Anthony Brino

Two large health insurers are hoping a new "public utility" patient data sharing service will improve one of the most pernicious problems in American healthcare.

June 2, 2014 | White Papers
Today, value-based payments reward successful health outcomes, increased quality of care, and higher patient satisfaction. For health plans, this shift presents dramatic challenges. For many, technology will be the key enabler of these new payment models.

April 2, 2014 | White Papers
A new paradigm for population health management

April 2, 2014 | White Papers
Better outcomes and new revenue streams mean hospital CFOs are increasingly excited about the opportunities presented by telehealth.

February 19, 2014 |
There is little doubt mobile technologies are poised to make significant contributions to improve the care of patients and to help payers significantly decrease the costs of treating chronic conditions. For this reason, adoption of mHealth technologies is accelerating at a rapid clip. With lower prices of mobile technologies comes increased deployment and in the process lower reimbursements. And while it is clear that people are engaged with their mobile devices, the trick under new care and reimbursement models is to find ways to leverage the various mHealth technologies to also get members actively engaged in their own healthcare. This white paper will explore those various technologies, including remote patient monitoring, the new era of home care and the old standby: texting.

November 20, 2013 | White Papers
Whether they realize it or not, most healthcare payers are losing millions of dollars each year across activities such as COB, subrogation, eligibility, MSP validation, and more. Fortunately, a new generation of "intelligent" cost containment solutions helps cut the losses and achieve significantly improved recoveries, cost avoidance, and increased revenue - all of which support health reform priorities such as medical loss ratio and waste and abuse efforts. This white paper details real-world examples of "intelligent" cost containment success, best practices for improvement, and more.

May 1, 2013 | White Papers
This white paper includes five strategic imperatives for providers facing dramatic transformations in the US health care system – and why analytics is the key to executing them. Read about how to: simplify data integration across the extended enterprise; manage the financial risks and incentives of emerging reimbursement models; proactively improve care quality and outcomes; drive greater efficiency of care delivery; and engage patients as unique individuals.

April 4, 2013 | White Papers
Accountable care offers the nation’s ailing health care system new hope — but it isn’t a new idea. For the past decade, health systems, payers, and providers across the country have been practicing accountable care principles through initiatives such as the Collaborative Payer™ Model, a care delivery innovation jointly developed by a payer and provider that approximates an accountable care organization.

April 4, 2013 | White Papers
This case study profiles a struggling Medicare Advantage business responsible for 11,600 lives in the southeastern United States. Lumeris recommended that the client implement the Collaborative Payer™ Model, an approach to improving clinical and cost outcomes via a strong payer-provider relationship. The company guided the client through a three-phase approach to develop this model, achieving outcomes including: earning appropriate revenue, reducing unnecessary utilization, improving quality metrics, and improving cost outcomes.

October 20, 2012 | White Papers
Recent claims data analysis, gathered for a 12-month period ending 3Q of 2011, found that 17% of all medical expenses were related to orthopedic services, and 80% of spine care costs associated with non-surgical services. This paper examines how the current health care delivery system can affect the quality of care and demonstrates how a conservative approach is a priority to more effectively manage expenditures and enhance outcomes related to evidenced-based, orthopedic treatment of musculoskeletal issues.


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