A unified workflow for all referrals, resulting in fewer clicks and less confusion, means provider matching can be conducted based on specialty, location, insurance, and real-time availability, for an easier track to the right provider, not just any provider.
Upended by chronic diseases and community realities, healthcare needs to shift its priorities to post-acute environments.
In a recent interview, Esperion president and CEO, Sheldon Koenig talks about the reality of statin intolerance and his company’s expansion into new diseases
We are currently experiencing an inflection point for progress in interoperability. Without meaningful reform to reflect the real world, the system risks repeating and even accelerating historical patterns of exclusion — leaving vulnerable patients behind.
CMS has introduced the MAHA ELEVATE model to expand lifestyle medicine in Medicare, a move experts support but say will hinge on effective implementation.
CMS’ new ACCESS model, slated to begin on July 1, aims to shift traditional Medicare fee-for-service toward value-based care by tying payments to patient outcomes and encouraging tech-enabled, preventive care. Experts say it could benefit digitally mature, value-focused providers first, but its overall success will hinge on clear metrics, better data sharing and sustained participation.
With new therapies being approved, and many others in the pipeline, they raise a critical question: Is our healthcare system prepared to deliver them effectively and sustainably?
Alan Murray on improving access for medical transportation.
Here are three things providers should consider when it comes to Medicare.
The go-to mechanisms for differential payment – network design, case management, quality measurement and prior authorization – increasingly rely on APIs capable of handling not only claims data but, more importantly, the clinical data critical to intelligent decision-making.
CMS and AHIP are raising the floor, but forward-thinking plans are aiming higher. They’re designing utilization management systems that are clinically sound, operationally efficient, and aligned with enterprise goals.
These updated guidelines are a good opportunity for SNFs to change how they operate moving forward. Those who start implementing new policies and objectives soon and begin to operate as one system, rather than prioritizing each outcome separately, will be the ones to see the greatest results.
Greenway Health blends smart technology with human expertise to elevate revenue cycle.
Care pathways are, in essence, the maps we follow to get patients from where they are to where they want to be. However, many rehab care plans are still too fragmented, too reactive, and too disconnected from the broader ecosystem of care. This won’t cut it in this next phase of transformation.
CMS’ new $50 billion rural health fund seeks to help rural providers sustain care in their communities over the next five years. However, experts believe the program will not be enough to stabilize the finances of rural hospitals — especially in the face of worsening reimbursement issues, an ongoing workforce crisis and billions of dollars’ worth of Medicaid cuts on the horizon.
CMS Administrator Dr. Mehmet Oz said that Medicaid’s rapid spending growth is unsustainable and criticized state financing tactics that let providers and governments “game” the system for extra federal funds. He said CMS is shifting its fraud strategy to follow the flow of money rather than just individual offenders in an effort to ensure health dollars are used for legitimate care.
Experts believe value-based care won’t ever reach scale unless fundamental barriers are addressed — including voluntary models, misaligned payer incentives, excessive metrics and weak employer engagement.
As an industry, we need to ask hard questions. Are delegated vendors delivering on the promise of better, faster, more transparent decisions? Or are they simply moving the pain to another part of the system?