By Amit Shah – HEDIS is a measurement set used to determine the efficacy of a payer to care for its members. The performance data collected through HEDIS assists payers in identifying areas for improvement as well as tracking successes through a measurement set that allows them to be compared to other payers.
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By Misty Graham – Key stakeholders in the healthcare industry, including health plans, clinical data registries, and accountable care organizations, must collaborate to improve health outcomes, enhance patient experiences, manage chronic diseases, and provide better access to care while keeping costs low.
By Lynn Carroll & David Wolf – The fundamental goal of value-based care (VBC) is to improve patient health outcomes by prioritizing preventive care and wellness, thereby reducing overall healthcare spending through better management of costly chronic diseases.
By Christie Scanlon – Within healthcare’s intricate landscape, a complex interplay exists among three principal entities: patients, providers, and payers. This dynamic can be likened to the “Three-Body Problem” in physics—a concept from Liu Cixin’s science fiction novel…
By David L. Morris – The healthcare industry is witnessing a monumental shift toward alternative payment models. Among them, capitation is growing in popularity as one of the most durable ways to stabilize costs and focus on preventive and primary care.
By Jocelyn Keegan – Healthcare technology policy, especially rules impacting payers, are coming at us at a fast and furious pace coupled with new enforcement teeth. Executives and leaders in payer organizations face a pivotal decision — Do they simply fulfill regulatory compliance requirements, or do they…
By Jason Brown – From initial claim submission to filling additional documentation requests, and responding to payer audits or denials, healthcare provider organizations dedicate significant time and resources to collaboration with payers.
By Lynn Carroll – The dramatic loss of revenue by healthcare providers during the COVID-19 pandemic was a sobering reminder that healthcare organizations rely on the traditional FFS revenue model at their own peril. In response, more provider groups are implementing APMs built around financial incentives.
By Michael Drescher – Health care has benefitted tremendously in the past decade from the explosion of data of all kinds. From more accurately identifying and tracking trends in care delivery, to developing the ability to predict the likely onset of disease, to documenting the real-world effects of…