Bundled Payments

August 4, 2014 | Anthony Brino

One of the largest Medicaid managed care expansions has been given the green light for what will be a test of reducing public-payer spending.

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 9, 2014 | Anthony Brino

UnitedHealthcare's bid to change financial incentives for oncologists has led to some promising, though somewhat mixed results.

June 13, 2014 | David Weldon

With population health management becoming a central focus for more healthcare providers, a growing number are considering adding a chief population health officer to the executive ranks.

June 11, 2014 | Richard Pizzi, Editorial Director

The value-based reimbursement model predicted by many to dominate the reimbursement market is also the one they say will be hardest to implement.

May 15, 2014 | John Andrews

Although accountable care organizations are still in their nascent stages, a few large provider groups and payers may be ahead of the curve on operations and performance.

March 25, 2014 | Anthony Brino

What's driving the highest per capita healthcare spending in the country? A half-decade's worth of government-funded research points to some contentious and perhaps uncomfortable trends.

February 27, 2014 | Mary Mosquera

The price of an initial inpatient stay explains almost all of the wide spending variation among hospitals on episodes of care, such as for knee or hip replacements, the National Institute for Health Care Reform has found. That finding is important for the move toward bundled payments.

February 18, 2014 | Anthony Brino

Humana is settling charges that it required some small businesses to buy life insurance policies along with health coverage going back to 2006.

January 31, 2014 | Mary Mosquera

Accountable care organizations saved more than $380 million after their first year, but only 29 were able to share in the savings.

January 14, 2014 | Stephanie Bouchard

Hospitals have been acquiring physician practices and have been doing so for years, but a case resting in the hands of a federal judge in Boise is proving to be a "banner" case for these sorts of mergers and acquisitions.

December 19, 2013 | Mary Mosquera

Oversight of the health insurance exchanges and the shift to value-based payments are the leading management challenges facing the Department of Health and Human Services in the coming year and the most concerning to the HHS Office of Inspector General.

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.

June 20, 2012 | White Papers
Insurers are efficiently and accurately paying millions of claims that they should never pay at all. In this white paper we define state-of-the-art prepayment analytic strategies and explain how they differ from both claims edit and postpayment detection systems.

June 20, 2012 | White Papers
In this case study, you’ll learn how Highmark dramatically reduced losses with a new analytic approach to preventing and detecting fraud, waste and abuse in submitted claims. Learn how this approach enabled Highmark to identify hundreds of new pursuable cases in the first year over and above cases identified through other methods.

December 12, 2011 | White Papers
Curtailing the massive drain caused by waste, abuse and fraud in healthcare has never been more important. New payment models are on the horizon, including bundled payments, and greater emphasis is being placed on payment for outcomes. Given the magnitude and visibility of the problem, insurers need to avail themselves of advanced and effective means to reduce wasteful, abusive and fraudulent medical spending in the most efficient way possible. This demands a more holistic approach across the payment continuum, using technologies that not only address issues from multiple angles but also facilitate cross-organization partnership. Read more now.


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