payers news from FierceHealthcare
NewsSPOTLIGHT: Five areas where provider management needs to evolve
The world of insurance is changing. Reform is spurring on innovation in new products, new types of incentive models and new types of care models. But what might that mean for payers? Read more...
Quality studies proposed for children's healthcareTo date, virtually all of the major studies of healthcare quality have focused on care for adults, partly because children aren't prone to chronic diseases like diabetes whose outcomes can be measured easily. The gap in quality measures is particularly large when it comes to inpatient care, according to a study by the National Association of Children's Hospitals. However, a new bill being considered in the Senate would change the equation, budgeting $100 million over the next five years … Read more...HHS asks employers to push transparencyHHS head Mike Leavitt is asking employers to commit to a set of four goals which aim to make cost and quality data more accessible to consumers. The goals include adopting health IT standards in order to make health information systems interoperable, increasing quality transparency, increasing pricing transparency, and offering rewards to encourage efficient, high-quality care. HHS has begun to develop specific quality and cost specs for employers to use in implementing the goals. The … Read more...SPOTLIGHT: Hospital-at-home care has come of ageWhile the idea of providing hospital care at home dates back to the 1960s, it hasn't been widely implemented yet, particularly in the United States. But it's high time that U.S. healthcare providers take a closer look at this approach, particularly given the technology we have available to support remote patients, argues Vince Kuraitis of Better Health Technologies. Not only does home-based hospital care save money, it sidesteps the risk of hospital-acquired infections and keeps the … Read more...Study ranks TX payer performanceIf you're a Medicaid provider in Texas, get ready to have your claims denied and your payments delayed. That's one of the conclusions drawn by a recent study of payers in Texas, conducted by physician practice management technology vendor Athenahealth. Athenahealth's Texas rankings, which analyzed claims performance for providers and medical practices from the second quarter of 2006, included 295,000 charge lines. Among other things, the study found that Texas Medicaid denied physician … Read more...SPOTLIGHT: Is P4P focusing on the right things?
Editor's Corner
Compliance programs help profits, patient careThe New York Times reports on compliance programs that are designed to get patients to stick to their drug regimens. These are both good for the patients' health and for pharmaceutical company profits, as many patients do not take all their prescribed drugs properly--especially for conditions for which symptoms are not obvious such as high-blood pressure. Several companies like McKesson and subsidiaries of manufacturers such as Pfizer Health Solutions have call centers … Read more...MEDecision goes after "claims-based" recordsMEDecision will create 6.5 million "patient clinical summaries" for Blue Cross Blue Shield of Illinois. The Pennsylvania-based software company was involved in the effort to create emergency clinical records after Hurricane Katrina. MEDecision President John Capobianco explained to FierceHealthcare at HIMSS that while less than 20 percent of providers currently use EMRs, their technology can mine claims in real time to create basic records for emergency room care, or to support … Read more...Editor's Corner
|
