Reimbursement
Healthcare industry executives around the world understand the need to collaborate but lack of trust among the sectors and unaligned incentives for stakeholders create hurdles.
Doctors may be cost-conscious, but price never trumps patients' best interests.
UPMC has invested more than $1.6 billion in its IT infrastructure over the past five years, according to Pamela Peele, chief analytics officer of UPMC Health Plan. That's more money, she points out, than its home city has spent on three pro sports stadiums combined – "and we take sports seriously in Pittsburgh."
Florida Blue Cross and Blue Shield is in the midst of reorganizing into a "policyholder-owned, not-for-profit mutual insurance holding company."
As healthcare delivery and reimbursement models transition to ensuring quality care versus quantity of care, some sectors of the healthcare industry will benefit more than others.
Lawyers for Cigna are asking a federal appeals court to reject a Houston hospital's bid to sue over withheld medical reimbursements, arguing that the provider's "prompt pay discounts" threw its cost-sharing model awry.
It's not surprising that the average person is pretty confused about the Affordable Care Act. It's a complex piece of legislation that gets phased in gradually, and opponents have been attacking the law and intentionally confusing people while proponents have been less effective about getting the word out.
As healthcare delivery and reimbursement models transition to ensuring quality care versus quantity of care, some sectors of the healthcare industry will benefit more than others.
WellPoint Inc., the second largest health insurer, posted better-than-expected second quarter earnings Wednesday by taming medical cost increases in its employer-based business and benefiting from the Medicaid operations in its recent Amerigroup transaction.
The seemingly millions of tasks for payers to be ready for the roll out of health insurance exchanges should be steadily shrinking as October swiftly approaches, but there is still much to do, including looking to the future.