In the News

Stories and trends changing the healthcare landscape

CMS Final Rule on Overpayments

gavel and law bookMedicare Advantage Plans, need to update your strategy? Provider responsibilities and look back periods are reduced in the CMS final rule for overpayments. See more information:

The Centers for Medicare & Medicaid Services has issued a final rule regarding the legal requirements providers most follow if they are overpaid.

New Ideas for Population Health Analytics Using Persona-Based Model

crowdSome Health Plans are charting new territory in population health management: Member centric clinical persona. In the traditional disease/condition categorization, many members were in separate and unconnected programs. The nine clinical personas are: healthy kids, healthy adults, acute kids and adults, ADD High-Cost/Rx, Serious Mental Illness/Substance Abuse/Other At-Risk, Uncoordinated Care, Chronic Coordinated, Complex Managed and Extreme Complex. We find the approach compelling. Read More.

Medicaid Health Plans Face Quality And Performance Ratings

best-quality-graphicProposed Medicaid Managed Care Organization regulations include quality ratings for private plans providing benefits, in addition to provider network certification and member education. These changes are aligned with Medicare plan requirements, although well behind the rest of the CMS programs focused on quality of care while reducing overall costs. However, Medicaid reimbursement levels are lower posing larger challenges. Will quality measures be less robust? Read More.

How Data and DNA Are Making Cancer Treatment a Personal Issue

TData and Medicinehe power of data to help personalize optimal treatment for cancer is exciting; yet even more exciting is the ability to prevent it. Even though the health care industry recognizes the risks to quality of life as well costs associated with a disease event, innovation and pro-active care will need to address proven/necessary treatment and the timing of the costs when health plan benefits are annual. Not only providers of care, but also employer groups, individuals, and multi-year government innovation will likely need to play the role of change agents.Read the story.

It Costs $10K More Annually To Treat People With Diabetes, Insurers Say

DiabetesIncreased diagnosis for first time insured individuals combined with convenience drug treatments are noted for a spike in costs around diabetes. At the same time, everyone agrees preventing complications is the real lever to reducing overall health care costs. The challenge continues: Insurance plans are renewed annually, yet the overall cost reduction is longer term. Is there an option to shift insurance plans from a 12 month cycle?. Read The Story.

 

Wave of consolidation engulfing health care systems

news sentinelRoughly a dozen mergers have taken place among health systems in Wisconsin in the past two years. Some have involved small rural hospitals, others large health systems.The mergers all have one thing in common: They were driven at least partly by the changes taking hold in health care. Read the Article

The Biggest U.S. Health Care Challenges Are Management Challenges

hbr business challengeFindings indicate it is not competition but internal change management as the largest hurdle as healthcare shifts from volume based to value based health care. From our point of view, It is not just strong leadership to steer the ship but also timely incentives. Proving value takes time, while volume rewards are fast. Read the story