Posts Tagged ‘health claims’

Infographic: The Reality of Healthcare Claims Denials

August 12th, 2016 by Melanie Matthews

Some 90 percent of healthcare claims denials are avoidable and two out of three denials are recoverable, according to a new infographic by ZirMed.

The infographic looks at the rates of claims denials, the cost of appealing denials and provides a timeline for working a denial.



Innovative Plan-Provider Ventures: Case Studies From Anthem and AetnaInnovative Plan-Provider Ventures: Case Studies From Anthem and Aetna provides the details of two case studies of plans and providers that are collaborating on value-based care models:

* Vivity, a collaboration between seven prestigious California health systems and Anthem Blue Cross of California, promises to improve quality and share cost savings among the participating entities.

* Innovation Health, the northern Virginia health plan owned 50-50 by Aetna Inc. and Inova Health System, represents a great example of an “alignment” structure, with the new health plan allowing the provider and carrier to tap into each other’s expertise to lower costs, grow market share and move to value-based payment.

Innovative Plan-Provider Ventures: Case Studies From Anthem and Aetna provides strategies to reduce coverage costs and improve outcomes.

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HINfographic: 9 Measures of ACO Success

March 12th, 2014 by Jackie Lyons

What is the mark of a successful accountable care organization (ACO)? For healthcare organizations, clinical outcomes topped the list of ACO success metrics.

This HINfographic depicts nine key ACO metrics identified by 138 healthcare companies. Also among the top three measures was patient satisfaction and health utilization.

9 Measures of ACO Success

 title= You may also be interested in this related resource: Guide to Accountable Care Organizations. This 160-page resource lays the groundwork for an ACO program. It includes a framework for clinical integration, a key ACO prerequisite that puts participating providers on the same performance and payment page, and much more.

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