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RISE to the occasion: quality, risk adjustment, payers, and providers converge

Posted by Sean Creighton and David Bartley on 3/21/17 10:56 AM

Although its Nashville location remains the same, the Annual RISE Summit continues to grow in size and importance each year. RISE, or the Resource Initiative and Society for Education, has been bringing its membership together for 11 years to address fundamental issues in risk adjustment, performance measurement and improvement, and payment integrity. The American Health Care Act, the GOP alternative to the Affordable Care Act, was a focal point for this year’s meeting with its release on the eve of the conference. However, RISE is well known for its best-practice sessions, and while the future continues to be debated, there is clearly plenty of work still getting done to move the industry closer to value-based healthcare delivery and payment even in the midst of uncertainty.

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watch: how big data and automation are disrupting healthcare

Posted by Verscend on 3/10/17 7:32 AM

How is the shift to value-based care creating a “perfect storm” for payers and providers to leverage big data as technology and automation evolve? And at the same time, how are these advances empowering healthcare consumers? Verscend’s own President and CEO Dr. Emad Rizk discussed these topics in depth recently at the 2017 Health Care Forecast Conference held at the Paul Merage School of Business at the University of California, Irvine.

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tips to drive your population health journey and avoid the potholes

Posted by Verscend on 1/18/17 9:50 AM

Whether your provider organization is just getting started on its population health journey or looking for a change from its current solution, there are many potholes to avoid along this challenging road—along with several side trips that could easily become a distraction from your ultimate goal. Check out our infographic below to help you steer in the right direction when it comes to choosing the tools you’ll need.

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how risk adjustment and predictive models drive effective value-based care

Posted by Verscend on 11/10/16 9:12 AM

Healthcare technology is constantly evolving and improving. Although risk adjustment and predictive models have long been established in the industry, their power and accuracy cement their status as a cornerstone for healthcare strategy and operations. Risk adjustment and predictive models provide critical insight into risk, utilization, and cost, as well as ensure fair comparisons between populations. Developments in modeling advance these fundamentals and provide new insights into healthcare trends that propel value-based care strategies.

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the keys to a successful quality improvement program

Posted by Verscend on 10/26/16 9:07 AM

A core requirement for health plans across the country is measuring and reporting on quality metrics. However, directly influencing those metrics can often be a struggle. Improving quality metrics is directly correlated with identifying and addressing gaps in care. By deploying a proactive, year-round strategy that aligns data analytics with a focused approach for addressing gaps in care, your organization can turn routine quality measurement and reporting activities into a true strategic advantage by ensuring that quality measurably improves across key metrics.

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taking action on maternity care variability

Posted by Sam Stearns on 7/13/16 10:53 AM

In April, Verscend’s Sam Stearns co-authored an article in Employee Benefit News titled, “5 ways employers can optimize the value of maternity care for employees.” We recently sat down with Sam and his team to discuss their research and expand on the recommendations in the article, and provide information that will benefit employers and providers managing the health of their employee population.

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decoding MACRA: implications and recommendations for provider organizations

Posted by Juliana Hart, BSN, MPH on 6/8/16 9:26 AM

There is one healthcare acronym that is currently impacting provider organizations across the country more than any other—MACRA. While MACRA, or the Medicare Access & CHIP Reauthorization Act of 2015 is not a new subject, a notice by the Centers for Medicare & Medicaid Services (CMS) in late April has elevated the urgency for providers to know and understand the proposed legislation and its repercussions.

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for providers, successful accountable care can start with employees

Posted by Verscend on 6/1/16 2:24 PM

Providers across the country are working to ensure that they are delivering high quality care that addresses the unique needs of each patient while driving clinical and financial outcomes. Requirements from payers and government entities focused on quality and outcome reporting, coupled with growing risk-based contract arrangements, requires providers to develop an accountable care strategy. But, many providers may wonder what steps they need to take in order to be successful. For providers with self-funded employee populations, building a population health management strategy around the employee population is a practical way to establish a foundation of skills, solutions, and knowledge that can extend to patients.

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Dr. James Colbert featured in Health Affairs

Posted by Verscend on 5/2/16 10:45 AM

In a recent Health Affairs blog post, Verscend’s Dr. James Colbert, along with co-author Dr. Ishani Ganguli, explore why we need to consider other data sources, particularly provider insights and patient-reported data, to best identify the right patients for targeted population health interventions.

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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). 

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