discover more with our blog

Read Verscend’s latest articles, news highlights and perspectives on the business of healthcare

Lets stay in touch. Subscribe to our blog:

healthcare news: week of August 29

Posted by Verscend on 9/2/16 11:23 AM

This week’s healthcare news highlights efforts by the Centers for Medicare & Medicaid Services (CMS) to balance the field among Affordable Care Act (ACA) exchange markets, updates on ICD-10 requirement flexibility, and the latest pushback from providers on the Medicare Access and CHIP Reauthorization Act (MACRA).

... Read More

8 tips for supporting your population health management programs

Posted by Verscend on 4/13/16 8:22 AM

Provider organizations have almost too many options when it comes to finding population health management expertise and system support, including analytics, data aggregation, clinical workflow/care management, and patient engagement. With the market expected to reach $4.2 billion by 2018, it’s not surprising that new vendors pop up practically daily, or that existing vendors are beefing up their solution portfolios to capitalize on the opportunity. As providers’ wish lists continue to grow—driven in part by government initiatives and commercial payers’ programs—system selection starts to take on the overwhelming feel of a second EMR implementation. This is causing providers to hesitate just when they need to act.

... Read More

Western Health Advantage leverages population health analytics to better serve patients

Posted by Verscend on 3/2/16 11:32 AM

Accountable care organizations (ACOs) show promise yet, regardless of their configuration, they continue to struggle with the practicalities of making the model work. Those that have found a way to succeed have much to share with the rest of the industry. Western Health Advantage is a provider-sponsored, not-for-profit HMO that has been operating like an ACO for the past 18 years. As Western Health Advantage moved into risk-sharing programs, stakeholders realized that the organization had outgrown its in-house reporting system. Without a new solution, Western Health Advantage would have a hard time grappling with one of the common challenges facing ACOs: meeting the extensive reporting requirements associated with the Patient Protection and Affordable Care Act (ACA). 

... Read More

bundled payments gather momentum

Posted by Richard Wheeler, MD on 2/24/16 1:13 PM

One of the attributes of a sustainable value-based healthcare delivery system is payment based on the value of services delivered, instead of the volume-based fee-for-service model. Bundled payments have been explored for several years as an alternative to value-based payment models and there have been some notable recent successes. A great example is Horizon Blue Cross Blue Shield of New Jersey’s episode of care program.  

... Read More

exploring new quality and payment initiatives

Posted by Juliana Hart, BSN, MPH on 2/16/16 2:00 PM

It’s no surprise that healthcare reform is greatly changing the playing field for providers. New reporting requirements and changes in reimbursement, among other drivers, are causing providers to focus on aligning their quality and payment initiatives to successfully move towards value-based care. While this transition is occurring gradually, factors such as geography, market share, and new federal programs play a role in determining which path forward might be best for a specific organization. 

... Read More

provider success in an ACO setting

Posted by James Colbert, MD on 1/20/16 1:28 PM

Recently, the Center for Medicare and Medicaid Services (CMS) announced the addition of 141 new Medicare Accountable Care Organizations (ACOs), bringing the total number of Medicare ACOs in the United States to nearly 500. In addition, hundreds of provider groups are also participating in accountable care arrangements with commercial insurance plans, and some have even formed ACOs with state Medicaid agencies. These changes are part of a larger initiative being led by CMS to move reimbursement away from fee-for-service and towards alternative payment models that emphasize value over volume.

... Read More

strengthening primary care and population health across accountable care

Posted by James Colbert, MD on 12/2/15 10:48 AM

On November 11, 2015 I had the opportunity to participate in a panel discussion on how provider  organizations are strengthening primary care in new payment models such as accountable care  organizations (ACOs). Joining me on the panel were Herbert Druilhet of Lafayette General Health,  Michael Jeremiah of Carilion Clinic, and Todd Walker of Rainbow Babies and Child ren’s Hospital. The  session was well attended and generated some lively discussion. In this blog post I’d like to share some  of the common themes that emerged from the discussion.
... Read More

post-acute care:strategies and analytics for ACO success

Posted by James Colbert, MD on 10/28/15 12:26 PM

With a goal to create a more efficient healthcare system, accountable care organizations strive to identify opportunities to reduce costs, increase quality of care, and improve utilization metrics. One area on the continuum of care that continues to challenge ACOs is post-acute care (PAC). PAC services occur either in specialized facilities such as skilled nursing facilities (SNFs), inpatient rehabilitation facilities, and long-term care hospitals, or at home through home health agencies. Since many of these services vary in cost, spending on PAC has grown significantly over the years and remains a large portion of total expenditures. To help better manage PAC utilization and costs, ACOs should consider the following five strategies:

... Read More

in the news: the importance of physician engagement

Posted by Richard Wheeler, MD on 8/12/15 9:42 AM

Physician engagement is one of the cornerstones of a sustainable value-based healthcare system. For those of us who were involved in the Health Maintenance Organization (HMO) movement in the 1980s, the risks associated with this attempted transition from volume to value became all too apparent as one HMO experiment after another ended in failure.  A key contributor in many cases was minimal if any physician input, making the attempts unsustainable. Many of the current efforts at moving from volume to value, such as the Accountable Care Organization (ACO) models, patient centered medical homes, and bundled payments, appear to have learned and applied this lesson from the past.

... Read More