Reimbursement

The value-based model of healthcare is gradually transitioning from the pilot phase to implementation, as health insurers and providers strive to offer better care while eliminating unnecessary costs. But for providers who have always been paid fee-for-service, it is a different way of thinking.

Before the next open enrollment begins, verification issues are lingering for several hundred thousand consumers on existing exchange plans, leaving insurers and providers facing a range of potential problems.

Predictive analytics uses a variety of statistical techniques that analyze current and historical facts in order to make predictions about the future. In the healthcare setting, such data analysis can be effective in addressing a variety of key issues, including preventable readmissions.

Narrow networks sparked consumer angst and new government oversight after the Affordable Care Act's first open enrollment period. But now, there's evidence that limited networks can be a win-win, albeit with one primary caveat.

With increasing regulatory pressure, payers are keen to adopt new technologies, improve efficiencies, implement analytics and build interoperable platforms, but are left looking for ways to access clinical data from providers and other caregivers. The challenge is often in getting a single, standard view of patient data and translating this data into actionable intelligence.

In the latest development of private health insurance exchanges, one large Blue Cross company is betting on the single-carrier model as a way to keep group business, or hopefully expand it.

A joint investment in a health IT company by two Blue Cross companies and a private equity firm is reaping a few billion amid healthcare's tech boom.

In its new rules, CMS places great emphasis on the physician's documentation regarding his or her expectation of a patient's need for hospital care and anticipated length of stay. Therefore, it is essential that all hospital physicians are educated about the heightened importance of documentation within the medical record.

Ahead of a corporate branding change and a new open enrollment period, WellPoint is charging ahead with accountable care and population health strategies.

As proton cancer treatment centers expand, payers and providers may have to collaborate to expand the evidence base, to avoid the highly-expensive technology crowding out other investments.