Accountable Care

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.

August 5, 2014 | Anthony Brino

A venture by Independence Blue Cross and a company ranking well in Warren Buffett's portfolio is getting underway, in an ambitious attempt to optimize the benefits of primary care.

July 31, 2014 | Stephanie Bouchard

The San Francisco Bay area is getting a new accountable care organization courtesy of the formation of a new company by two healthcare powerhouses in the region.

July 29, 2014 | Stephanie Bouchard

As payers and employers put pressure on providers to assume more financial risk, providers are struggling to assess the impact of the risk they have already assumed.

July 25, 2014 | Rodney Moore

With new incentives, hospitals are increasingly making the reduction of complications, infections and readmissions a priority, but there are still infrastructure gaps that can tangle payer-provider collaboration.

July 21, 2014 | Anthony Brino

The diabetes and obesity epidemics mean more Americans may suffer from heart disease before they turn 65, challenging payers to craft better intervention models that help prevent serious cardiovascular events and increased spending on acute care.

July 21, 2014 | Erin McCann

It's a chilling reality often overlooked in annual mortality statistics: Preventable medical errors persist as the number three killer in the U.S. and the source of great waste.

July 16, 2014 | Anthony

In a region dominated by one insurer and teeming with health systems, accountable care models are gaining provider acceptance but still accumulating evidence.

July 16, 2014 | Anthony Brino

After quietly building a small insurance unit, one of the nation's largest health systems is launching a new health plan brand that could pose more competition for established insurers.

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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