Administrative prior authorization requirements increasingly used to steer patients to lower-cost settings
Hospital finances could be significantly impacted by UnitedHealthcare’s expansion of site-of-service prior authorization requirements going into effect Nov. 1.
Healthcare reform moves to the states: Strategies to increase access and control costs
An increasing number of states are looking to improve access and reduce costs by funneling innovations, such as a public option or reinsurance program, through Medicaid.
7 top macro trends impacting providers, insurers and healthcare consumers today
The healthcare industry's shift to a consumerism focus is occurring in parallel with seven significant emerging trends that are affecting providers, insurers and healthcare consumers alike.
3 components of shared risk executives need to know
Jennifer Carney, vice president, finance and analytics, for Beth Israel Lahey Health Performance Network (BILHPN), describes three basic components of shared-risk contracts.
Analysis: Initial thoughts on the President’s recent Medicare executive order
A review and insight on several key points in the President’s Medicare executive order issued Oct. 3.
Analysis: Walmart’s Sam’s Club unveils discount healthcare pilot program
A review of the Walmart Sam’s Club discount healthcare pilot program in three states and how the insight the company gleans about utilization and customer preferences will inform its health clinic concept pilot.
Direct contracting models offer promise of expedited shift to value-based care
CMS’s Direct Contracting Models offer providers some substantial benefits, including access to capitation payments for Medicare fee-for-service members — without the investment costs in brokers and marketing to move members into Medicare Advantage.
3 features that distinguish BCPI-A from its predecessor
There are three primary ways in which the Bundled Payments for Care Improvement Advanced (BCPI-A) differs from the original BPCI model.
How to present data to physicians to obtain their buy-in for a BCPI-A initiative
Healthcare administers should take four actions when presenting data to physicians to elicit their support for a initiative under the Bundled Payments for Care Improvement Advanced model.
Analysis: How a longer-term delay to Medicaid DSH cuts may play out
A review of CMS’s recent rule finalizing the ACA’s mandated Medicaid DSH cuts for FY2020 and how it may play out if some legislators demand changes to the rule.