Consumer-centric front office uses data and outreach to engage members

Under the Affordable Care Act, health plans have been striving for a business model that shifts away from an employer-centered approach to one that puts consumers at the center of their organization. At this point in time, the health care marketplace still lags behind other industries in this transition. While there isn’t a singular approach […]
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Four steps to population health management: Step four— Expand chronic disease management to the full attributed population

In our last blog post, we talked about high-acuity patients, such as those with chronic conditions, who are at high risk for admissions and readmissions. These patients, who drive a disproportionate amount of health care costs, need to be closely monitored post-discharge and targeted for intervention to keep them on the road to recovery. Using […]
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Intriguing insights help identify next steps in creating a culture of health

Among large employers, 62% say it’s important to establish a culture of health. Yet only 23% say they’ve achieved it. Findings like this from the Fifth Annual Wellness in the Workplace Study reveal that while companies are strongly committed to workplace wellness, most still struggle with achieving a true culture of health. Our study of […]
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Putting the patient first: Innovative care models and patient engagement

Now that the concept of using data and analytics to manage the health of an attributed population is widely accepted, it’s time to move the conversation toward the next step: innovative care models and patient engagement. Payers and providers must not assume that stratifying clinical risk and enrolling high risk patients in care management will […]
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Provider engagement has a major impact on quality, costs and outcomes

Health care market dynamics now impose risk adjustment and quality standards on financial performance across all market segments — Medicare Advantage, Managed Medicaid and commercial plans. To balance risks, improve quality and decrease costs, plans must move beyond retrospective claims analysis and basic assessments. Improving plan performance also hinges on provider engagement. A changing market […]
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Tell your employees: it’s not too late to maximize the HSA contribution

As 2014 draws to a close, it’s a good time to remind employees to maximize their health savings account (HSA) contribution to leverage the account’s tax benefit. Under-contributing to an HSA is a common health benefits mistake employees make and one that can be avoided. The IRS sets the guidelines for how much employees can contribute […]
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IT strengthens payer–provider partnerships as Value-Based Reimbursement arrangements take hold

With new reimbursement models, changing regulatory dynamics and broad quality initiatives, providers and health plans are feeling the pressure to increase their focus on the value of health care services delivered for premium dollars. Risk is now being transferred from payers to providers, blurring the distinction between the two entities. Increasingly, both groups face the […]
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Four steps to population health management: Step three — Invest in in-home intervention

In our last blog, we discussed the importance of helping patients make seamless transitions to their homes or another care facility following their stay in the hospital. Through care management programs supported by data analytics, providers can identify and help patients who need a little extra help — and prevent costly re-admissions. The next step […]
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Collaboration is key to big data effectiveness

Big data holds big promise in health care. By utilizing data that comes from a variety of sources and covers a variety of populations, there is a virtually limitless potential for improving the quality and the value of care being delivered. A huge challenge with big data, however, lies in the accessibility of data. Much […]
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Pressure to perform: What health care finance leaders are thinking

Today, hospitals are reeling from financial and compliance pressures due to a combination of bad debt, newly covered patients, changing reimbursement models, and the risk of denials in the face of the migration to ICD-10. Health care organizations are looking for more effective and new approaches to optimizing revenue cycle management performance across the enterprise. […]
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