Our own Dave Schweppe (Chief Analytics Officer) and David Wolf (AVP, Payer Solutions) sat down with Todd Sauers, Manager of Value-Based Care Analytics at Sentara Health, for a fireside chat to discuss current trends and opportunities in value-based care. In this vibrant conversation, the experts talked through various perspectives and thoughts on the impact of…

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Every patient has a plethora of data associated with their health record, which can include decades of enrollments, claims, accounts and charges. Much of this data is not housed within the same institutional, facility or provider database…

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Value-based care remains top of mind for payers and providers alike. However, continued misalignment between payers and providers can hinder their ability to achieve cost and quality goals. A recent Quest Diagnostics study shows that 62 percent of health plan executives feel that payers have made progress in aligning with providers, while only 41 percent of physicians agree with this notion. What’s more, according to an HFMA survey commissioned by MedeAnalytics, an overwhelming 88% of providers say they are not ready for value-based care.

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Following a surge of cesarean section (C-section) operations for expecting mothers, doctors in California must now reduce the number of C-sections performed to 23.9 percent for low-risk births. The state’s health insurance marketplace under the Affordable Care Act, Covered California, wants to curb this rate to improve patient safety and quality. Any hospital that doesn’t […]

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Collaboration between payers and providers is an important asset to improving quality of care across the healthcare ecosystem, while simultaneously keeping costs down. For example, payers have access to a significant number of claims data that creates a holistic view of patients’ information, while providers typically have discrete clinical data information. By working together to […]

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As the health demands of patients expand, payers are increasingly focused on a small segment of their member population that is driving the largest share of healthcare spending: high-cost members. According to the American Health Policy Institute, these high-need, high-cost individuals can cost $100,000 every year, which accounts for one-third of total healthcare spending. As […]

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In our last webinar, titled: Streamlining Your Quality Processes, our very own Bruce Carver, Associate Vice President of Payer Services, addressed the challenges and strategies needed to ensure health plans were succeeding with quality management. The healthcare landscape, especially for payers, has changed. With the introduction of MACRA and now with nearly 500,000 physicians submitting […]

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In all areas of healthcare, organizations are looking for innovative ways to reduce costs and improve quality. According to a new study published in Health Affairs, MACRA could reduce CMS physician services spending from $35 billion to $106 billion. MACRA is also leading the way towards quality healthcare by creating incentives and penalties for providers […]

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