Policy

As the healthcare industry focuses on cutting costs, narrow provider networks designed to deliver value are taking hold as a widespread business practice.

Most providers associate clinical documentation improvement (CDI) with the transition to ICD-10 coding, however, CDI - a process in which care providers receive feedback from specialists who review clinical documents - may also deliver clinical and financial benefits for healthcare organizations.

Fewer patients linger for days in hospitals without being admitted because of a new federal rule, but hospital and consumer groups are suing the government because they say the policy compromises Medicare patients' care, and patients are often stuck with costly, unexpected bills.

One insurer's experimental reimbursement model proved to lower the total costs of care for patients with 3 types of cancer. As an alternative to the traditional fee-for-service payment model, the episode payment model-which reimburses physicians on a fixed-price, based on episodes of best-practices and patient outcomes-provided encouraging findings in the battle against the rising costs of cancer care in the United States.

Vaccination prices have gone from single digits to sometimes triple digits in the last two decades, creating dilemmas for doctors and their patients as well as straining public health budgets.

Looking to control Medicaid costs, several states are launching accountable care initiatives that mirror experiments underway with Medicare and private insurers but vary significantly in their approaches.

The authors examine the association between advanced electronic health record (EHR) use and cost in hospitals. Patients treated in hospitals with advanced EHRs cost 9.66% less.

Smart watches, mHealth apps, and Bluetooth scales may just be edging into the social consciousness as a viable way to monitor personal health and manage chronic diseases, but EHR developers have been eyeing these technologies for some time, seeing them as valuable tools in the struggle to engage patients, prevent unnecessary readmissions, reduce costs, and promote long-term health.

Hospital outpatient prices for standard blood tests, cancer screening and other services varied widely and were sharply higher, on average, than prices charged by ambulatory clinics and independent doctors, an analysis of autoworker health-plan spending across 18 cities has found.

Terri Bernacchi, strategic consultant, audit and risk assessment, CIS, identified value-based contracting (VBC) as a forward-thinking approach for pricing and market needs. She discussed how VBC can improve formulary access, how it can impact the healthcare insurance exchanges, and how it can influence provider/payer reimbursement models.

What is value and how do we define it? In a panel discussion led by moderator Jean-Paul Gagnon, former senior director, Sanofi-Aventis, participants were asked to analyze the ways in which healthcare can shift from a fee-for-service model to one that focuses on value.

The Senate introduced legislation this week that would require Medicare to consider patients' finances when deciding whether to punish a hospital for readmission numbers.

Jeffrey Albright, director national accounts, Jazz Pharmaceuticals, said that many patients' access to specialty pharmaceutical products can be limited as health plans struggle to control costs. He provided important insight into pharmaceutical manufacturers' strategies, which aim to optimize appropriate patient access to the medications and products they need through various services that can provide reimbursement support.

While the fee-for-service reimbursement model has long been accepted as the standard model in healthcare, it must shift to one that focuses on value. Value-based reimbursement will encourage stakeholders to achieve the triple aim: improve patient experience, better manage population health, and reduce per-capita costs of healthcare so that patients receive more for the dollar spent, said Dan Sontupe, executive vice president, payer marketing & market access, The Cement Bloc.

Once strictly the domain of research labs, gene-sequencing tests increasingly are being used to help understand the genetic causes of rare disease, putting insurance companies in the position of deciding whether to pay the $5,000 to $17,000 for the tests.

Initiation of guideline-preferred first-line antiretroviral therapy (ART) was associated with better ART adherence and persistence and similar total healthcare expenditures among Medicaid-insured HIV patients.

This study examines whether patients treated with specialty pharmaceuticals have improved outcomes compared with patients treated with conventional therapies, and evaluates costs associated with these treatments.

As the bill for providing healthcare in the United States continues to grow, hospitals are finding that many of their expenses can be chalked up to patients with chronic illnesses such as diabetes and heart failure taking avoidable trips to the emergency room (ER).

Despite reform and shifts in health policy, the United States healthcare system ranked last in quality compared with 10 other industrialized counties-just as it did in 2010, 2007, 2006, and 2004.

Trimming the costs of diabetes to the healthcare system will take multiple strategies, but there's a lack of consensus on precisely how each will work. Are the new recommendations on statins worth the cost?

Negotiating cash payments with medical providers outside the managed-care realm can save a bundle.

Autism exacts a heavy toll on families across the country, but what is the financial cost of the disorder?

Patients who want to compare prices for prostate-cancer surgery may find it rough going: a study has found a 13-fold difference in prices quoted by 100 hospitals across the United States. Moreover, most provided little more than broad estimates, and only three gave a hard copy of the charges.

Cleveland Clinic CEO Dr. Toby Cosgrove will not take over the scandal-ridden Veterans Affairs Department and will remain in his current job.

The White House is considering Toby Cosgrove, MD, president and CEO, Cleveland Clinic, to be the next secretary of the Department of Veterans Affairs.