By Christie Scanlon – Within healthcare’s intricate landscape, a complex interplay exists among three principal entities: patients, providers, and payers. This dynamic can be likened to the “Three-Body Problem” in physics—a concept from Liu Cixin’s science fiction novel…
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By David L. Morris – The healthcare industry is witnessing a monumental shift toward alternative payment models. Among them, capitation is growing in popularity as one of the most durable ways to stabilize costs and focus on preventive and primary care.
By Jocelyn Keegan – Healthcare technology policy, especially rules impacting payers, are coming at us at a fast and furious pace coupled with new enforcement teeth. Executives and leaders in payer organizations face a pivotal decision — Do they simply fulfill regulatory compliance requirements, or do they…
By Jason Brown – From initial claim submission to filling additional documentation requests, and responding to payer audits or denials, healthcare provider organizations dedicate significant time and resources to collaboration with payers.
By Lynn Carroll – The dramatic loss of revenue by healthcare providers during the COVID-19 pandemic was a sobering reminder that healthcare organizations rely on the traditional FFS revenue model at their own peril. In response, more provider groups are implementing APMs built around financial incentives.
By Michael Drescher – Health care has benefitted tremendously in the past decade from the explosion of data of all kinds. From more accurately identifying and tracking trends in care delivery, to developing the ability to predict the likely onset of disease, to documenting the real-world effects of…
By Patty Hayward – The healthcare payer space has shifted radically in recent years, with evolving reimbursement models, the rise of healthcare consumerism, advances in technology, and a global pandemic that upended businesses.
By Matthew Albright – The issue of surprise billing has long plagued the U.S. healthcare system. The need for legislation to protect individuals from surprise billing is strikingly clear, as studies reveal that one in five emergency room visits result in an unexpected bill for patients.
By Susan Bellile – As we kick off 2022, one of the big questions surrounding interoperability is the status of the payer-to-payer data exchange rule. The requirement was part of the May 2020 Final Rule supporting the 21st Century Cures Act, and its enforcement was scheduled to start on January 1. However, in September CMS delayed enforcement pending future rulemaking.