Payment Reimbursement and Managed Care

Calling Into Question the Nation’s Commitment to Value-Based Health Care

There is widespread agreement that the goal of transitioning the nation’s healthcare system to value-based payment is important, but there remain many impediments to accomplishing such a transition.

Gail R Wilensky, PhD October 27, 2017

Ask the Experts: Payer Preference for Imaging Centers

Our hospital is beginning to feel the sting of payers steering their members from scheduled high-end imaging procedures at our facility to free-standing imaging centers. How are other hospitals and health systems responding to or reacting to this practice?

HFMA October 16, 2017

Understanding the Problem of Claim Processing Waste

Even small improvements in connectivity and transparency could save a few dollars per healthcare claim, which adds up very quickly.

Erin Murphy October 16, 2017

United HealthCare ACO Contract Emphasizes Quality

The NexusACO health plan incentivizes patients to use top-performing physicians.

Lola Butcher October 16, 2017

Cost: The Biggest Barrier to Precision Medicine

Joel Diamond explores the cost barriers of genetic testing to precision medicine.

Joel Diamond October 12, 2017

Rethinking Health Care’s Triple Aim

Achieving health care’s Triple Aim has proved elusive, but it may be yet be achievable through a process of engaging rising-risk patients in their own care through daily self-reporting.

Jim Evans October 4, 2017

Creating Value in the Medicaid Expansion: A Strategic Framework for AMCs

Academic medical centers that work with states to find mutually beneficial Medicaid strategies may find themselves well positioned in an era of value.

Michael J. Schwartz October 4, 2017

Targeted Care Integration Can Help Drive Success Under Risk Contracts

Providers can avoid many of the missed opportunities associated with risk contracts by carefully reviewing the targeted patient population, narrowing the number of performance metrics, and selecting the right clinicians to participate.

Laura Ramos Hegwer October 3, 2017

HFMA Trendsetter: Tackling Bundled Payments

This article shares how Premier Inc. helped Adventist Health System successfully navigate bundled payment initiatives by offering a dynamic collaborative led by seasoned experts and user-friendly analytics that enable evidence-based decisions.

HFMA October 2, 2017

Sidebar: Top 10 Most Over-Documented HCCs

Documentation of chronic conditions is increasingly important as hospitals move toward value-based payment models. 

HFMA October 2, 2017
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