Industry News
Employers: More cost sharing, surcharges and telemedicine
DirectPath and CEB, reported by MCOL
3/5/2016
This week DirectPath and CEB released their 2016 Medical Plan Trends and Observations Report, which analyzed more than 750 employee benefit health plans. The eleven page report highlights their top ten trends in the 2016 health care strategies of employers and notes year-over-year shifts.
2017 HHS Risk Adjustment Model Changes: Final Rule Impact
3/14/2016
On February 29th, the Department of Health and Human Services (“HHS”) released the Notice of Benefit and Payment Parameters for 2017 (“NBPP for 2017”) Final Rule. Though many items mentioned in the draft NBPP were deferred, a number of changes have been incorporated that will impact health plans’ risk adjustment results. The following is a summary of the major changes related to risk adjustment, potential impact to plans’ risk scores, and action items plans should take to prepare.
New Podcast: Big News in 2017 MA Draft Call Letter
Gorman Health Group
3/15/2016
"On payments, the Centers for Medicare & Medicaid Services (CMS) came in with a higher than expected rate that was better than last year and exceeded expectations in the 2017 Medicare Advantage (MA) Advance Notice and Draft Call Letter, said John Gorman, Executive Chairman at Gorman Health Group (GHG).
A Key to Value-Based Reimbursement—Now and In the Future
4/11/2016
All health plans are moving into value-based reimbursement with their providers, with many already there. For example, a report from Healthcare Benchmarks, on Value-based reimbursement contracts, December 2015, shows Commercial payers had 69.6% of their contracts under the model and for Medicare it was already 58.7%. In other words, the majority of contracting is already using the value-based model.
Provider-sponsored health plans: positioned to win the health insurance market shift
Deloitte Development LLC
4/12/2016
Deloitte's Center for Health Solutions sought to understand how provider-sponsored plans have performed financially in recent times. They analyzed the financial and market performance of provider-sponsored managed care organizations during 2012- 2014. The analysis yielded 3 primary findings.
The 7 Best Ways to prepare for MACRA Today
5/5/2016
The Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law in 2015, with major impacts starting in 2019. MACRA attempts to prioritize quality over quantity by letting providers choose between two value-based payment tracks: MIPs and APMs. Providers won’t have to choose until 2019; until then, they will receive a .5 percent annual increase.
A Key to Value-Based Reimbursement—Now and In the Future
V. Katherine Gray, PhD, President, Sage Health Management Solutions, Inc.
5/17/2016
All health plans are moving into value-based reimbursement with their providers, with many already there. For example, a report from Healthcare Benchmarks, on Value-based reimbursement contracts, December 2015, shows Commercial payers had 69.6% of their contracts under the model and for Medicare it was already 58.7%.
Major health systems, payers make progress toward value-based payment goal
Ayla Ellison, Becker's Hospital Review
6/7/2016
The Health Care Transformation Task Force, a private-sector alliance aimed at accelerating the healthcare industry's transition to value-based care, reported Tuesday that 41 percent of its provider and payer members' business were in value-based payment arrangements at the end of 2015, up from 30 percent the year prior.
Provider-sponsored health plans Positioned to win the health insurance market shift
Deloitte
6/7/2016
Health systems are increasingly moving to health insurance as a means to population health management. They are participating in VBC payment arrangements, where they
can share savings if they reduce spending while meeting quality goals. But even greater savings potential exists if health systems assume full risk for all health care services
for a defined population rather than share savings with a health plan.
Beyond compliance: Properly leveraging ERM for additional value
Amreen Rehman, RSM
6/27/2016
Enterprise risk management (ERM) is a successful approach for managing risk, but it is often not utilized to its full potential. While companies are under pressure to focus risk management efforts on compliance and regulatory demands, a more holistic strategy can leverage ERM to drive additional business value.
50 healthcare apps for clinicians and consumers to know
Max Green and Brooke Murphy, Becker's Healthcare
7/22/2016
It seems like every week brings news of a new healthcare startup company whose app garnered millions in early funding. Not all of these apps will take off, and many are still vying to snag the dominant spot in their respective categories. The same can be said for apps in the telehealth, prescription management, physician reference, patient portal and house call categories. Here are 50 of the most-talked about, most-downloaded apps to know for both patients and providers.
HCEG offers discount to Alliance members
HCEG
7/27/2016
Health Care Executives Group, an Alliance industry partner, is extending a special discount to Alliance members. The discount includes membership in HCEG and attendance at their annual forum, September 12 – 14 in New York City.
10 things keeping health system CEOs up at night
Molly Gamble and Ayla Ellison, Becker's Hospital Review
8/22/2016
Health system CEOs are asked to perform the highwire act of managing change in the industry while keeping operations steady and finances healthy. Whether the CEO of a large integrated system or a smaller regional organization, health system leaders are confronted with many of the same pressing issues. Here are 10 issues leaving health system CEOs most concerned…
Tackling contradictions of population health, and five key success factors
Hospitals and Health Networks
9/6/2016
Managing population health in the United States has always intrigued me: Why should hospitals be engaged in these efforts? After all, most of a hospital’s revenue has been generated by providing sick care and performing procedures, not so much by preventing illness.
Get a free pass to attend MCOL webinar, Oct 5th: Trends in Provider Sponsored Health Plans
MCOL
9/22/2016
Managed Care On-Line (MCOL) event co-sponsored by Health Plan Alliance. MCOL is giving one free pass per each Alliance member plan. To arrange to receive your comp pass...