Accountable Care

April 21, 2014 | Anthony Brino

Leaders from the Centers for Medicare & Medicaid Services think private insurers have been too slow to adopt payment reforms, but they would be best served by adopting value-based payment systems in tandem with CMS today.

April 21, 2014 | Mike Miliard

Behavior change is critical to better outcomes, for patients, as well as providers and payers, as one health system with an insurance arm is finding.

April 14, 2014 | Anthony Brino

As payers on behalf of states and the federal government, Medicaid managed care organizations have the potential to drive reforms, and if they don't, they could be on the chopping block.

April 8, 2014 | Anthony Brino

Independence Blue Cross and DaVita HealthCare Partners are launching a new joint venture aiming to personalize, improve and ultimately reduce costs for chronic disease care in one of the country's most expensive healthcare markets.

March 20, 2014 | Anthony Brino

A central hypothesis underlying the case for health reform's insurance expansion is being challenged by new evidence, as the quest to reduce emergency visits and spending continues. The research also highlights ongoing concerns about primary care access.

March 11, 2014 | Erin McCann

Aetna is going forward with an accountable care agreement for some 28,000 people, partnering with a health system that also has accountable care contracts with some competitors.

March 4, 2014 | Anthony Brino

Colorado is moving ahead with an experiment for Medicare-Medicaid eligible beneficiaries, or "dual-eligibles," using a payment system many others are trying to abandon. But the state's approach incorporates a variation on the concept of the accountable care organization that's showing promise elsewhere.

February 26, 2014 | Mary Mosquera

Although highly touted, the patient-centered medical home model failed to lower use of services or total costs and produced little quality improvement over three years, research in the latest Journal of the American Medical Association (JAMA) has found.

February 20, 2014 | Mary Mosquera

Blue Cross Blue Shield of Michigan has expanded its value-based hospital reimbursement model with five more health systems in the state, representing 24 hospitals, for a total of seven systems.

February 17, 2014 | Mary Mosquera

When CVS Caremark announced that it would no longer sell cigarettes, it was the latest sign of the direction retail pharmacies have been moving in over the last few years.

February 6, 2014 | Mary Mosquera

Aetna reported higher fourth-quarter profits propelled by revenue from its Coventry Health Care acquisition and is looking to its Medicare and managed care business for growth in 2014.

February 5, 2014 | Anthony Brino

Florida Blue and the nation's second largest public healthcare system are launching a clinical integration program in South Florida with a bold bet on the evolving frontier of paying for value.

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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