In the News
Stories and trends changing the healthcare landscape
Medicare uncovers claims overpayments due to incorrect units of service and provider coding errors. CMS states Medicare contractors should collect their overpayments – how many outpatient overpayments are overlooked? Most focus on inpatient only. We can help!See More
Some 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.
Which “more specific” diagnosis/symptom/injury code is your favorite with the release of ICD-10 in October?
At Well Solutions Group, we picked “Pecked by a Chicken”, but “Bitten by a Cow” was a close second. Read More
Proposed 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.
The 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.
Increased 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.
Roughly 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
Findings 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
CMS’s Next Generation ACO’s – “allows participants to take on more financial risk with more predictable financial targets and the potential to obtain a greater reward.” – and continues to keep the focus on quality of care over quantity of care. Read the article
Initial Results are in on CMS Bundled Payments Year 1. Lower lengths of stay. Reduced utilization of skilled nursing facilities substituted for home health, all resulting in for overall cost of care. Both ER and readmissions rose initially, and then fell to the baseline rates. Read the article