Monthly Archives: October 2014

Blue Cross Alternative Quality Contract Lowers Costs, Improves Patient Care: Study

A Blue Cross Blue Shield of Massachusetts (Blue Cross) Alternative Quality Contract (AQC) improved quality of patient care and lowered costs in the four years since it was implemented, according to an independent study by Harvard Medical School published in … finish reading Blue Cross Alternative Quality Contract Lowers Costs, Improves Patient Care: Study

Posted in Accountable Care Organizations, affordable care act, Alternative Healthcare Coverage, Avoidable Hospitalization, Cardiac Care, Care Coordination, Clinical Integration, Disease Management | Tagged , , , | Leave a comment

New Payment Models Reduce Reimbursement Challenges for Embedded Case Management

Understanding where a practice is and where it wants to go helps to ease the challenge of embedding case managers into physician practices, says Annette Watson, RN-BC, CCM, MBA, senior vice president of community transformation for Taconic Professional Resources. She … finish reading New Payment Models Reduce Reimbursement Challenges for Embedded Case Management

Posted in Avoidable Hospitalization, Care Coordination, Care Transitions, Case Managers, Case Managers and the Patient Experience, Embedded Case Manager | Tagged , , , | Leave a comment

Cultural Competency Between Case Manager and Patient Breeds Engagement, Retention

Communicating with vulnerable patients effectively, whether it’s about medication non-adherence, or simply what is or isn’t working, requires a certain level of cultural competency between the case manager and patient, says Jay Hale, LPC, CEAP, director of quality improvement and … finish reading Cultural Competency Between Case Manager and Patient Breeds Engagement, Retention

Posted in affordable care act, Avoidable Hospitalization, Behavioral Health, Care Coordination, Care Transitions, Case Managers, Case Managers and the Patient Experience, Diabetes, Disease Management, dual eligibles, Elderly Care | Tagged , , , | Leave a comment

New CMS ACO Investment Model Supports Coordinated Care for Rural, Underserved Areas

Up to $114 million in infrastructure and redesigned care processes is being invested in up to 75 eligible Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP), according to the Centers for Medicare & Medicaid Services (CMS). … finish reading New CMS ACO Investment Model Supports Coordinated Care for Rural, Underserved Areas

Posted in Accountable Care Organizations, affordable care act, Alternative Healthcare Coverage, Avoidable Hospitalization, Care Coordination, Comprehensive Primary Care Programs | Tagged , , , , | Leave a comment

BCBS of Illinois Specialty Intensive Medical Home Targets Most Critically Ill

Designed to improve patient access, care coordination and illness management, Blue Cross and Blue Shield of Illinois (BCBSIL) has launched the first specialty intensive medical home (IMH) program in the state with the Illinois Gastroenterology Group (IGG), the state’s largest … finish reading BCBS of Illinois Specialty Intensive Medical Home Targets Most Critically Ill

Posted in Accountable Care Organizations, Avoidable Hospitalization, Behavioral Health, Care Coordination, Case Managers, Clinical Integration, Comprehensive Primary Care Programs, Medical Home | Tagged , , , | Leave a comment

From Diabetes Management to Medical Home Recognition: The Health Coach’s Changing Role

Areas like diabetes management are not just the domain of physicians or case managers; today, health coaches often provide patients with diabetes the necessary tools and resources to manage it, says Alicia Vail, RN, a health coach at Ochsner Health … finish reading From Diabetes Management to Medical Home Recognition: The Health Coach’s Changing Role

Posted in affordable care act, Alternative Healthcare Coverage, Avoidable Hospitalization, Behavioral Health, Care Coordination, Emergency Room, Health Coaching, Medical Home | Tagged , , , , | Leave a comment

Anthem, Hartford Healthcare Renew Value-Based Agreement; Integrate Behavioral Health, Chronic Care Programs

Anthem Blue Cross and Blue Shield and Hartford Healthcare (HHC) have renewed an accountable care agreement designed to broaden their value-based arrangement, create tighter integration and enhance care coordination, according to Hartford Healthcare officials. In addition to their current partnership, … finish reading Anthem, Hartford Healthcare Renew Value-Based Agreement; Integrate Behavioral Health, Chronic Care Programs

Posted in Accountable Care Organizations, Avoidable Hospitalization, Behavioral Health, Clinical Integration | Tagged , , | Leave a comment

3 Ways Embedded Case Managers Can Support the Hospital Discharge

Ensuring that patients understand their discharge instructions and can afford their medications are two ways embedded case managers can support the hospital discharge, says Irene Zolotorofe, RN, MS, MSN, and administrative director of clinical operations at Bon Secours Health System. … finish reading 3 Ways Embedded Case Managers Can Support the Hospital Discharge

Posted in Avoidable Hospitalization, Care Coordination, Case Managers, Case Managers and the Patient Experience, Embedded Case Manager, Emergency Room | Tagged , , , | Leave a comment

CMS Releases Data on Financial Relationships Between Healthcare Industry, Doctors, Teaching Hospitals

Designed to help consumers understand the financial relationships between healthcare industry officials, physicians and teaching hospitals, and promote transparency and accountability, CMS has released the first round of Open Payments. The program, created by the Affordable Care Act (ACA), lists … finish reading CMS Releases Data on Financial Relationships Between Healthcare Industry, Doctors, Teaching Hospitals

Posted in affordable care act, Hospital Ranking, Hospital Services, Physician Alignment, Physician Organizations, Prescription Drugs | Tagged , , , , , | Leave a comment

6 Elements of Highmark’s Pay-for-Performance ‘Best Practices’ Project

At Highmark Inc., physicians are eligible for bonus payments across a broad spectrum of measures from clinical and quality measures to prescribing habits, access to care and level of technology use. In addition, practices can also qualify for a bonus … finish reading 6 Elements of Highmark’s Pay-for-Performance ‘Best Practices’ Project

Posted in affordable care act, Comprehensive Primary Care Programs, Healthcare Reform, Healthcare Utilization, pay-for-performance, Physician Alignment | Tagged , , | Leave a comment