Reimbursement

The trend toward value-based payment for healthcare services is gaining momentum. For better or for worse, we have paid for healthcare in the U.S. on a fee-for-service basis – from the perspective of providers (doctors, hospitals, etc.), that means that the more you do, the more you make. Except for efforts around managed care, where a fixed capitated (per-member-per-month) fee is paid to risk-taking organizations for a defined population of patients (the HMO model), fee-for-service has been at the core of how we do business in healthcare.

Medicare could benefit with improved care and savings if seniors could access healthcare services online, according to a study that found that increasingly more tech savvy older consumers are interested in using digital health tools in their home.

President Barack Obama's bid to throw a life preserver to stranded consumers who received cancellation notices from their health plans may lead to financial losses and uncertainty for payers and increase bad debt for hospitals.

The new face of Medicaid may be underemployed millennials, but that may bode well for Medicaid's finances.

A new poll from the Ponemon Institute has found that security preparedness is still sorely lacking across healthcare – a fact that could leave unsuspecting organizations "blindsided" by breaches.

Medicare physicians will get smacked with a 24 percent payment cut on Jan. 1, 2014, unless Congress takes action. So it's not surprising that healthcare industry associations are publicly calling for an end to the payment mechanism that will effectively slash their reimbursement.

To not only survive in but also successfully adapt to a reformed healthcare marketplace, insurers are taking varied diversification paths -- some of them betting against history.

Concentrated economic power, combined with fee-for-service incentives, has made healthcare "the least consumer-friendly" U.S. industry and enabled arbitrary and capricious price gouging, according to the man behind Time magazine's "Bitter Pill" feature.

University Hospitals has signed a new accountable care collaboration with Cigna that will enhance care coordination and reduce costs and reach some 10,000 people covered by the company's health plan and who receive care from the 1,500 primary care physicians and specialists employed by UH.

Among the biggest obstacles in getting health plan members to comparison shop is the popular notion that "you get what you pay for" -- because it's actually true in most other industries.