Value Based Care
Bridge the Payer/Provider Data Gap
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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Payers and providers: Are you aligned on value-based care?
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.
Read MoreCalifornia mandate to lower C-sections will impact population health – how can analytics help?
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 […]
Read MorePayer and Provider Collaboration Ensures the Industry is Tracking Towards Value
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 […]
Read MoreManaging high-cost members with analytics
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 […]
Read MoreEPM Series: Learn How to Create Organizational Alignment with Performance Management
With the shift to value-based care, new payment models now reward organizations that focus on improving quality and lowering costs and penalize those that do not. Under these models, organizations are now required to report on additional metrics and are faced with major time constraints as they try to ensure proper documentation. Because of this, […]
Read MoreWant to Know How to Receive Higher Quality Scores?
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 […]
Read MoreBest Practices for Providers Looking to Improve the Quality of Care
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 […]
Read MoreHow are you Tracking to Value-Based Care?
It’s no secret that today’s healthcare landscape is changing. As costs rise and reimbursement models change, healthcare organizations are continuing to track towards value instead of volume. With this transition comes the rising importance of quality, especially since payers and providers are now dependent on quality measures for reimbursement. According to CMS, these measures are […]
Read MoreCase Study: How one East Coast Hospital Achieved 12% Savings with Population Health Data
Due to rising healthcare costs and the shift to value-based care, many organizations are now looking to improve quality and reduce costs. In our recent case study, we highlight how St. Joseph Hospital, part of Covenant Health, was able to leverage our population health solution and consulting services to adopt an innovative approach to population […]
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