Reimbursement

Blue Cross Blue Shield of Michigan (BCBSM) has launched a value-based hospital reimbursement agreement that includes shared savings with Northern Michigan's Munson Healthcare.

In an effort to raise awareness of hospital price variation, the California Public Employees’ Retirement System and Anthem Blue Cross started a “reference pricing” initiative in 2011. It appears to be having an impact.

During the first eight months of this year, fewer than 18 percent of Medicare patients ended up back in the hospital within a month of discharge, the lowest rate in years, the federal government reported Friday.

Northern Michigan's Munson Healthcare and Blue Cross Blue Shield of Michigan are venturing into the developing world of new payment models by launching a value-based hospital reimbursement agreement.

America's medical cost inflation appears on track to fall even below 2013's trends, according to PricewaterhouseCoopers, although consumers are still bearing large cost burdens and other trends threaten the slowdown.

In one of the strangest Medicaid fraud cases in recent history, the Justice Department is charging several Russian diplomats and their families with illegally accessing Medicaid-covered prenatal and pediatric care in New York City.

A key component to making value-based payment models work is getting physicians on board. But while physicians are supportive of the improved care coordination of such models, they are wary of how the payment structure will work.

Many experts predicted that the opening of the healthcare exchanges would be rife with technological glitches. As it turns out, they were correct.

Aetna has formed an accountable care organization with PinnacleHealth System for its commercial plan members in the Harrisburg-Central Pennsylvania area, one of multiple value-based models launched recently in the state.

Existing market share has been a fairly good predictor of health plan participation in the federal exchange, although new entrants like CO-OPs may give some a run for their money, according to a Milliman report.