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Trends in Healthcare Payments: Opportunities Are Endless for ProvidersProviders are using outdated practices to connect with patients for their bills.
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What Is a Complication, Anyway?When asked “what is your surgical site infection rate?” one will get an answer that is almost certainly removed from reality.
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Closing the Gap on Health InequalityAccess to testing for early diagnosis of chronic conditions, and use of data to find care gaps, will reduce health disparities.
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Recognizing Diversity and Cultural Differences in Healthcare OrganizationsIt is imperative for organizations to support diversity and acknowledge individuals’ differences in order to foster better morale, promote creativity and innovations, improve decision making, and create social justice that advocates equity.
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Contributor: Eating Disorder Claim Lines Rose 65% Across Nation From 2018 to 2022A white paper from FAIR Health found that claim lines and telehealth usage for eating disorders had increased in a span of 4 years.
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A Better Emergency Department Patient Access StrategyImproving patient collections in fast-paced, high-volume clinical environments.
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Expect Reference-Based Pricing to Get a Serious RebootReference-based pricing is about to get a serious reboot, with even more healthcare purchasers engaging in the practice and those that are already using it reviewing existing contracts with increased scrutiny.
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Contributor: Do Health Plans Have a Plan to Help Employer-Purchasers Get Better Value?This article is co-written by Suzanne Delbanco, PhD, MPH, executive director, Andréa Caballero, MPA, program director, and Julianne McGarry, MPP, director of projects and research, for Catalyst for Payment Reform, and Robert S. Galvin, MD, chief executive officer, Equity Healthcare, LLC.
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The Legal Landscape of TeledermatologyTeledermatology is advertised a major breakthrough in telehealth. But, is the tort system ready for widespread adoption?
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Most Hospitals Receive Failing Score in at Least 1 Quality Dimension of Their Community Health Needs AssessmentDeveloping clearer guidelines for measuring a hospital's orientation toward population health would be a big step towards fundamentally improving population health and changing the relationship between a hospital and its community.
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Need Healthcare? Let's Go Shopping or NotWe all shop. Every day we decide which products and services to buy. But shopping for medical care, typically, has been different.
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Three Proposals That Would Kill the 340B ProgramThe 3 prescriptions for reforming the 340B Drug Discount Program proposed by authors in the December issue of Evidence-Based Oncology would limit safety net hospitals' abilities to treat vulnerable patients.
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Contributor: Congress Must Act to Stop America’s Amputation EpidemicThe Amputation Reduction and Compassion Act (H.R. 2631) would ensure that Medicare and Medicaid both cover peripheral artery disease screening for at-risk beneficiaries without the cost-sharing requirements that could make some patients balk at seeking care.
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Maximizing Your Potential for Reimbursement Under the Quality Payment ProgramIt’s midway through the year and practices most likely have selected their quality measures and are collecting data to meet the reporting requirements under CMS’ Quality Payment Program under the 2018 Final Rule. But how do you know your practice is working to maximize your performance? It is all about communication and planning.
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Improving Patient Outcomes Through DataFor caregivers to use data properly, they must understand that much of the actionable data lives outside the healthcare system.
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Number of Manufacturers and Generic Drug Pricing From 2005 to 2017Regardless of the number of manufacturers, generic drug prices presented double-digit average increases from 2012 to 2015.
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Managed Care Reflections: A Q&A With Julia Adler-Milstein, PhDTo mark the 30th anniversary of The American Journal of Managed Care, each issue in 2025 includes reflections from a thought leader on what has changed over the past 3 decades and what’s next for managed care. The March issue, which is our annual health information technology (IT) theme issue, features a conversation with Julia Adler-Milstein, PhD, professor of medicine at the University of California, San Francisco, and guest editor of the 2014 health IT issue.
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Cross-Sector Data in ActionA look at the experiences of 2 leaders in cross-sector collaboration show how cross-sector data can guide the development of innovative initiatives to improve people’s lives.
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CMS Announces Transformative Updates to the MA VBID ModelUpdates to CMS' Medicare Advantage (MA) Value-Based Insurance Design (VBID) model broaden the scope of the existing model by testing a wide range of MA service delivery and/or payment approaches.
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Too Much, Too Fast: Providers Need More Time to Operationalize Medicare's New Radiation Oncology ModelCMS' new radiation oncology payment model is slated to begin on January 1, 2020, but the significant billing changes that the model requires will require more time.
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Measuring Value for Low-Acuity Care Across SettingsTo analyze value of low-acuity care, an existing model is adapted to highlight factors impacting how stakeholders assess emergency department care compared with alternatives.
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The Essential Facts of Life Are the Foundation of HealthOn a humanitarian mission to Puerto Rico, Adam Sharp, MD, learned that to improve health, the essentials of food, housing, and water must be available and should be prioritized over medications, surgeries, and therapies.
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Contributor: Institutional Engagement With Physicians Is Key to Managing Cost and QualityAlthough physicians’ clinical decisions serve as the biggest drivers behind the cost of care, hospitals have long been reluctant to take financial accountability. If such accountability is to be transformed from a diffuse fear to a manageable managerial task, institutional engagement with physicians will be a critical next step.
