payment models

Value-based payment update: Where we are and who is most successful
Value-based payment update: Where we are and who is most successfulWhile these types of programs have been in place for several years, it can be difficult to gauge who is using them and how, and whether they are achieving their intended goal.
Time for payment models to stop discriminating against in-home care
Time for payment models to stop discriminating against in-home careAmerican healthcare delivery is seriously dysfunctional. It takes patients about three weeks to get a doctor’s appointment, they sit in the waiting room for a long time, get 10 to 12 minutes with the doctor and then have a hefty deductible and/or copay despite paying handsomely for insurance.
One insurer proves that value-based reimbursement works in practiceHumana’s value-based reimbursement model with physicians has helped to improve care quality and health outcomes for its Medicare Advantage (MA) program members.
CMS releases first CJR bundled payment results: What to knowCMS just released the first Comprehensive Care for Joint Replacement (CJR) data feed. Find out what the preliminary results show.
CMS divulges CPC+ regions: What you need to knowDoctors in these states are now eligible for CPC+. Experts share how to prepare.
Healthcare providers make strides in telemedicine uptickA KPMG expert discusses the biggest drivers and challenges for expediting the adoption of virtual care.
How to understand medical necessity and how it controls physician paymentA lot of the questions and answers I see in Coding Insights involve “medical necessity.” Who defines this? How does this directly impact payments?
Superior pay for non-performance model threatens dermatology, societyThe economies of scale leading to superior pay are only realized in huge ACOs that cover large numbers of patients who are healthy or face entry barriers to the medical system. While treating dermatologic conditions improves patient quality of life perceptions, it does not lead to decreased healthcare utilization. The best approach for dermatology issues is to tell the patient their psoriasis is really very minor, not worth treating, and it is unnecessary to see a dermatologist.
Time to step up
Time to step upPharmacists can make big contributions to the healthcare team — and healthcare systems are leaning on their expertise more and more.
Docs treading lightly with new payment modelsSurprising way a group of surveyed physicians are saying what they think is the best way to control costs.