Setbacks and successes: What we've learned from the first year of commercial...
Qualified health plans completed their first year of commercial risk adjustment reporting and the Centers for Medicare & Medicaid Services reported the results.
View ArticleAll signs point to value-based care: Are you ready?
With the current shift to value-based reimbursement, providers are facing noteworthy changes as healthcare consumers are under more financial pressure than ever before.
View ArticleRAPS, EDPS and risk adjustment: the health plan perfect storm
Commercial and government programs have witnessed a busy year -- most notably with the first year of commercial marketplace EDGE server data submission for risk adjustment; reinsurance coming to a...
View ArticleClik here to view.
Healthcare finance leaders as chief storytellers
In support of strategy formulation, finance plays a vital role in helping other leaders to understand the organization's current financial picture, and to show the financial ramifications of proposed...
View ArticleClik here to view.
4 myths about the healthcare EFT standard, debunked
While it's been in effect since January 2014, the Healthcare EFT Standard via ACH is still a source of confusion for many medical providers.
View ArticleTransforming provider relationships is key to engaging consumers
U.S. health plans today operate in a world of rising expectations. They must work to contain rising healthcare costs, while at the same time catering more to consumers as the ultimate users of their...
View ArticleEngaging providers means aligning their goals with that of the consumer
In our last column, we took a look at how U.S. health plans operate in a world of rising expectations based on: value-based reimbursement; consumerization; healthcare cost management; and regulatory...
View ArticlePlans should be prepared for the difference between operational and financial...
In the first part of this series, we looked at a transformative year in healthcare and presented the ongoing shift from the Risk Adjustment Processing System to the Encounter Data Processing System....
View ArticleAffordable Care Act rate stabilization program results should guide strategy...
Earlier this year, the Centers for Medicare and Medicaid Services released the results of the first year of the reinsurance and risk adjustment provisions of the Patient Protection & Affordable...
View ArticleClik here to view.
Payers must change dynamic with providers to survive in the post-Affordable...
Finding the path to success in the post-Affordable Care Act world of healthcare represents a great opportunity and challenge for payer organizations. Part of that journey is changing the relationship...
View Article