Regulatory Compliance

The term “Accountable Care Organization”, or ACO, is used to describe a primary physician centric healthcare delivery system with a shared savings compensation model. ACOs are primary physician-centric groups of doctors, specialists, hospitals, and other health care providers, who voluntarily come together with a proper legal structure which aims to provide coordinated high-quality care to […]

The Federal Register outlines the following pros from comments received on the adoption of X12 Version 5010 for HIPAA Transactions: 1) reduction in analysis time and minimization of companion guides; 2) improved efficiency through improved eligibility responses and better search options, reducing phone calls to providers and health plans; 3) improved electronic posting, automation of […]

Escalating costs and suboptimal quality of care are indicators that the healthcare system is broken. Preventative care is being pushed aside and traded for costly ER visits and inpatient hospital stays. The problem does not end here, however; once patients receive the necessary inpatient care, many are discharged to only end up back in the […]

Many of you are counting on your EMR vendors to qualify your organization for Meaningful Use. This is a risky strategy. Dr. Rowley has done some analysis and shown that with two exceptions, all attestations count for less than 10% market share from the EMR vendors. This means you are most likely waiting for the […]

Malcolm Gladwell, staff writer for the New Yorker magazine and author of “What the Dog Saw,” “Outliers,” “Blink” and “The Tipping Point,” offered an overview of “Cowboys Versus Pit Crews: How to Build a Sustainable Health Care Delivery System” at our start of Day 3. Gladwell was introduced as “gifted” at interpreting new ideas in […]

AHIP CEO Karen Ignagni kicked off Day 2 by addressing the elephant in the room…no Supreme Court ruling today. The fate of the Affordable Care Act (ACA) and “the Mandate” within would have to wait another day. Ignagni went on to remind the conference goers that similar attempts at state-based reform in the mid-90s resulted […]

As referenced in the introduction to “America’s Health Insurance Plans (AHIP) Conference,” the decisions that will shape our nation’s health care are near. The Supreme Court Decision. The Presidential election. Implementation decisions within health plans that are shaping the delivery of care. The intent of the June 20-22 conference in Salt Lake City is to […]

The 2012 AHIP national conference is almost upon us. Our team will be at the June 20-22 event in Salt Lake City. With all of the changes we are witnessing in the health insurance industry, this year’s conference promises to address the many needs of conference attendees. Whether it is meeting regulatory compliance issues or […]

If you are still thinking about your strategy for Meaningful Use, I want you to stop right now and write me a check for $5,000 for every physician in your practice. I promise I’ll put the money to good use. This is conceptually what happens if you don’t act immediately. You have just given away […]

The U.S. healthcare industry has come head-to-head with tremendous challenges that have the potential to cripple the industry and reap havoc on multiple stakeholders, whose different interests and incentives have made change and progress difficult. However, a new era of data-driven healthcare is emerging as players are starting to explore the power of “big data.” […]

ACOs are paving the way for a healthcare payment model that is based on quality and efficiency instead of volume. They were created as a response to health reform initiatives that focus on improving patient safety, quality of care and affordability. As the name suggests, ACOs are institutions that collectively share the risks associated with […]

Spurred on by Meaningful Use, there has been an explosion in the implementation of EHRs over the last several years. This tidal wave has been sweeping through the healthcare community, sucking up much of the available bandwidth that organizations have to deal with change of this magnitude. The effect is really no different than what […]