Reimbursement

Health plans looking to change member behavior to produce better health outcomes need to take a multivariable approach to member engagement.

The Centers for Medicare and Medicaid Services has its work cut out in transitioning to ICD-10. As the largest payer and the force driving the new code sets in the United States, CMS has a task at least as intimidating as anyone else in implementing ICD-10.

In an effort to provide some sense of certainty about an ACO's ability to reach the so-called triple aim of reducing cost, improving quality and enhancing patient experience, the National Committee for Quality Assurance (NCQA) released on Monday its standards and guidelines which are the basis of its ACO accreditation program.

A new analysis by the Medical Imaging & Technology Alliance (MITA) finds that Medicare spending on medical imaging continues to decline, and that Medicare patients are receiving fewer imaging procedures.

Electronic health records will become the norm, sooner than later, experts said at a summit hosted by the Office of the National Coordinator for Health IT (ONC).

Aetna and Banner Health Network will create an accountable care organization made up of Banner employed and affiliated physicians and hospitals in Arizona. The ACO will employ information technology and a team-based approach to care for patients.

Last week, I discussed four competencies that would be required to create a health plan from scratch: 1) operating at peak administrative efficiency, 2) engaging consumers, 3) shifting risk in productive ways and 4) creating the clinical outcomes-driven business. Although traditional IT strategies have often focused on automating existing processes, the new health plan will need to focus on supporting these new competencies with technology.