Bundled Payments

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.

November 25, 2013 | Mary Mosquera

Physicians across a number of specialties are taking the lead to test developing new payment and delivery models. But they need more support from commercial and public payers to make them more widely adopted.

November 13, 2013 | Anthony Brino

Blue Cross and Blue Shield of Michigan is extending its value-based reimbursement model to the northern part of the state.

October 31, 2013 | Mary Agnes Carey, Kaiser Health News

The Democratic and Republican leaders of two key congressional committees have agreed on a framework to scrap the problematic Medicare payment formula for physicians and replace it with one that would link physician reimbursement to the quality of care provided, a step that could put an end to the annual "doc fix" debate.

October 31, 2013 | Anthony Brino

Cigna raised its full-year outlook after a third strong quarter, although the company's executives and investors are worried about sustaining earnings from Medicare Advantage, which saw high quarterly claims costs.

October 8, 2013 | Anthony Brino

Amid what the Kaiser Family Foundation calls "some of the most significant changes to Medicaid since its enactment," California Medicaid policy is evolving at perhaps the quickest pace, trying to manage the $55 billion in annual spending.

October 7, 2013 | Tammy Worth

After almost a year of preparation, 450 healthcare organizations begin taking part in Medicare's Bundled Payments for Care Improvement initiative this month. The goal is to evaluate if paying for care by episodes really can improve quality and reduce Medicare's costs.

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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